Care transition of older adults from hospital to home

Objective: To analyze the quality of care transition of older adults who were discharged from hospital to home. Methods: This is a cross-sectional observational study, conducted with 156 older adults after public hospital admission, located in the municipality of Piracicaba, state of Sao Paulo. Data were collected in patients' electronic medical records and by telephone calls with older adults, their relatives and/or caregivers, up to four weeks after hospital discharge. We used a questionnaire with sociodemographic data and the Care Transitions Measure, version validated for Brazil. Results: The mean duration of the last hospitalization was 8.27 days, mostly caused (72.44%) by COVID-19 and 75% of older adults had between 1 and 3 comorbidities, with hypertension (57.7%) being the most frequent. The mean CTM-15 score was 68.6. Factor 1, Management preparation, obtained the highest score (70.5), and Factor 4, Care plan, the lowest (59.14). There was a positive correlation between the 4 factors of Care Transitions Measure, also among these factors is the number of drugs used to treat older adults, according to the Anatomical Chemical Therapeutic Classification. Conclusion: We evidenced the quality of the transition of care in the hospital close to the value considered satisfactory, with two of the four factors with a score greater than 70;however, there is a need to adopt strategies to improve the discharge process from hospital to home, especially with regard to preferences imported and care plan for older adults.

Birth under restrictions: Exploring women's experiences of maternity care in Aotearoa New Zealand during the COVID-19 lockdown of 2020

Introduction: In Aotearoa New Zealand the COVID-19 pandemic in 2020 resulted in a four-week lockdown in March and April of 2020 with ongoing restrictions for several weeks. Aim: To explore the experiences of women who were pregnant, giving birth and/or managing the early weeks of motherhood during the 2020 COVID-19 alert levels 3 and 4 in Aotearoa New Zealand. Method: This qualitative study used semi-structured interviews to explore childbirth experiences during the COVID-19 alert level restrictions. Reflexive, inductive, thematic analysis was used to identify codes, subthemes and themes. Findings: Seventeen women participated in the study. Analysis of the qualitative interviews revealed four themes. The first of these was: Relationship with my midwife, in which participants described the importance of the midwifery continuity of care relationship, with midwives often going above and beyond usual care and filling the gaps in service provision. In the Disruption to care theme the participants described feeling anxious and uncertain, with concerns about the hospital restrictions and changing rules. The participants also described their Isolation during postnatal care in a maternity facility due to separation from their partners/whānau;they describe receiving the bare necessities of care, feeling they were on their own, and working towards their release home;all of which took an emotional and mental toll. The final theme, Undisturbed space, describes the positive aspects of the lockdown of being undisturbed by visitors, being better able to bond with the baby and being able to breastfeed in peace. Conclusion: Midwifery continuity of care appears to have supported these women and their families/ whānau during the service restrictions caused by the COVID-19 lockdown. The partner, or other primary support person, and whānau should be considered essential support and should not be excluded from early postpartum hospital care.

Stakeholders' experiences and perception on transitional care initiatives within an integrated care project in Belgium: a qualitative interview study.

BACKGROUND: In 2015, a plan for integrated care was launched by the Belgium government that resulted in the implementation of 12 integrated care pilot project across Belgium. The pilot project Zorgzaam Leuven consists of a multidisciplinary local consortium aiming to bring lasting change towards integrated care for the region of Leuven. This study aims to explore experiences and perceptions of stakeholders involved in four transitional care actions that are part of Zorgzaam Leuven. METHODS: This qualitative case study is part of the European TRANS-SENIOR project. Four actions with a focus on improving transitional care were selected and stakeholders involved in those actions were identified using the snow-ball method. Fourteen semi-structured interviews were conducted and inductive thematic analysis was performed. RESULTS: Professionals appreciated to be involved in the decision making early onwards either by proposing own initiatives or by providing their input in shaping actions. Improved team spirit and community feeling with other health care professionals (HCPs) was reported to reduce communication barriers and was perceived to benefit both patients and professionals. The actions provided supportive tools and various learning opportunities that participants acknowledged. Technical shortcomings (e.g. lack of integrated patient records) and financial and political support were identified as key challenges impeding the sustainable implementation of the transitional care actions. CONCLUSION: The pilot project Zorgzaam Leuven created conditions that triggered work motivation for HCPs. It supported the development of multidisciplinary care partnerships at the local level that allowed early involvement and increased collaboration, which is crucial to successfully improve transitional care for vulnerable patients.

Individualized Care and Follow-Up in Outpatient Surgery: A Pilot Study.

Introduction In outpatient surgery, post-discharge follow-up calls are essential for identifying complications and are considered a cost-effective intervention. Currently, there is a lack of scientific evidence to support the development and validation of standardized protocols adjusted to patients' specificities. Our aim is to develop a personalized model for our outpatient surgery unit (OSU) to create an individualized follow-up strategy in the future. Material and methods We performed a retrospective, cohort, single-center study, including patients undergoing surgery at an OSU of a tertiary hospital in Portugal, for three months. Follow-up calls were performed on the seventh and fourteenth days after discharge. The variables analyzed included: sex, age, surgical specialty, anesthetic technique, American Society of Anesthesiologists (ASA) physical status classification, surgery duration, and complications. A binary logistic regression was adjusted for the complications detected in each call. Results Nine-hundred eighty-four (984) patients were included, of which 79.8% (n=785) and 75.3% (n=741) answered the follow-up calls on the seventh and fourteenth days after discharge, respectively. Complications were reported in 47.1% (n=370) and 29.8% (n=221) of these calls, respectively, with pain having the highest incidence rate (44.7% in the first call; 26.6% in the second). The type of anesthesia and surgical specialty were independent risk factors for complications (p<0.001). Each minute increase in surgery duration increased by 1.1% the odds of complications (95% confidence interval 1.003-1.018) in the first call. Compared with no anesthesiology involvement, general anesthesia, regional anesthesia, and monitored anesthetic care are 2.52, 2.04, and 1.75 times more likely to have complications detected in the first call and 3.21, 2.36, and 3.11 times more likely to have complications on the second (p<0.05 for all). A model that predicts the detection of complications in each call was created. Discussion Outpatient surgery may allow procedures to be carried out safely, efficiently, and cost-effectively. To optimize the outcomes, it is important to quantify results as a tool for honing our strategies. The present study recognized the influence of several variables in the incidence of post-discharge complications. Also, considering the complications reported, pain was the most frequent among the reports and should not be neglected. In our reality, no follow-up calls are routinely performed after the seventh day, and complications were reported in that period, meaning some patients probably should be accompanied for a longer period. Conclusions To ensure the quality of care and patient safety and satisfaction, it is essential to identify and manage postoperative complications. Despite not being a routine contact, the incidence rate of complications on the seventh and fourteenth postoperative days is noted. According to our investigation, the type of anesthesia, surgical specialty, and duration of surgery should be carefully considered when establishing individualized follow-up plans. These plans, using tools adjusted to the population of each OSU, such as the calculator presented, may allow the available resources to be used with the greatest potential benefit for both patients and healthcare systems.

The Association Between Family Medicine Appointment Cancellations and Hospital Utilization in 2019 and 2020.

INTRODUCTION: The COVID-19 pandemic caused a disruption in the usual primary care services offered and received by patients. The objective of this study was to compare the impact of family medicine appointment cancellations on hospital utilization metrics both before and during the COVID-19 pandemic within a family medicine residency clinic. METHODS: This study is a retrospective chart review of cohorts of patients with a family medicine clinic cancellation who presented to the emergency department during a similar time period before and during the pandemic (March-May of 2019 vs March-May 2020). The patient population studied has multiple chronic diagnoses and prescriptions. Hospital admission, hospital readmission, and length of stay for hospitalizations during these periods were compared. The impacts of appointment cancellations on the emergency department presentation with subsequent inpatient admission, readmission, and length of stay were examined using generalized estimating equation (GEE) logistic or Poisson regression models to account for the lack of independence between patient outcomes. RESULTS: A total of 1878 patients were included in the final cohorts. Of these patients, 101 (5.7%) presented to the emergency department and/or hospital in both 2019 and 2020. An increased odds of readmission was associated with family medicine appointment cancellation regardless of year. The effects of appointment cancellations were not associated with admissions or length of stay between 2019 and 2020. CONCLUSION: Between the 2019 and 2020 cohorts, appointment cancellations were not associated with significant differences in likelihood of admission, readmission, or length of stay. A higher risk of readmission was associated with patients with a recent family medicine appointment cancellation.

MH service delivery, 988 gratitude, on readers' minds in 2023

Editor's note: Last week in Mental Health Weekly's Annual 2023 Preview Issue, we featured some of your responses to the most pressing challenges and new opportunities that await you in the new year. Here are more of your responses. Thanks to all who submitted comments.

Trust Takes Two .

Research throughout the COVID-19 pandemic, including investigations of resulting pandemic response strategies, evolving public health recommendations, and vaccine development, has highlighted the role of trust between physicians and patients. The focus, however, has largely been on patient trust in physicians. Although the importance of patient trust in physicians has long been recognized, physician trust in patients remains underappreciated. Physician trust in patients is an important factor in the physician-patient relationship. When physicians trust patients, patients can communicate freely, their experiences are validated, and trust may be engendered through reciprocal trust. Thus, a bidirectional approach to trust is necessary that acknowledges the role of physician trust in patients. We posit that shared trust is the dyadic factor that influences positive patient outcomes and is the foundation of shared decision making. Recognizing shared trust as an important outcome of the physician-patient relationship is a necessary step in evaluating how our practice, research, and education can influence or sow distrust of patients. In this commentary, we discuss the importance of attending to shared trust and physician trust in patients, particularly in family medicine.

Countermeasures for Healthcare Disruptions During Lockdowns.

Many countries did not have alternative healthcare arrangements during their initial COVID-19 lockdowns. This is surprising as partial and full lockdowns have been previously used to manage terrorism and the SARS outbreak of 2002-2003. This paper examines how lockdowns disrupt normal healthcare services and discusses countermeasures that can be used during lockdowns regardless of the emergency that engendered them. Solutions are discussed pragmatically with front-line clinicians, healthcare managers, and policymakers in mind. Mental health services are used as a case in point with generalizable lessons for other healthcare specialties.

A pragmatically before-after trial of tele-visits vs face-to-face visits for chronic patients during the COVID-19 pandemic: patient-reported adherence.

BACKGROUND: During the COVID-19 pandemic, chronic patients are at a higher risk of contamination with the virus. Specific strategies are required to restrict these patients' exposure to contaminated areas and improve medication adherence. One suggested strategy is tele-visiting, which is effective for the continuity of care and medication adherence during the pandemic. OBJECTIVE: The present study aimed to explore the effect of tele-visiting services via telephone on chronic patients' medication adherence before and after implementing a tele-visit program during the COVID-19 pandemic. METHODS: All patients received the tele-visit twice on the phone during the study. To compare patients' medication adherence in face-to-face visits and tele-visit, an adapted version of the Morisky Medication Adherence Scale-8 was used. Paired-samples T-test was run to measure participants' medication adherence before and after the tele-visit program. RESULTS: The tele-visit was run for 314 patients. The participants' adherence score before the intervention was 60.02, and after the intervention was 59.9. As the paired-sample T-test results showed, the difference between these two was not statistically significant. Moreover, medication adherence was not significantly associated with any of these variables: BMI, occupation, comorbidities, duration of disease, age, gender, marital status, and education level. CONCLUSIONS: The present findings showed that chronic patients' medication adherence did not differ significantly in face-to-face visits and tele-visiting. During the Covid-19 pandemic, due to the effectiveness of tele-visiting services, they can be used effectively to lower the transmission rate of the disease and reduce healthcare providers' burden.

Patient experiences during the COVID-19 pandemic: a qualitative study in Dutch primary care.

BACKGROUND: Changes in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positively and negatively. AIM: To assess the experiences of patients in primary care during the COVID-19 pandemic. DESIGN & SETTING: A qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands. METHOD: A qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach. RESULTS: Twenty-eight patients were interviewed (13 men and 15 women, aged 27-91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, seeing unfamiliar doctors, and care being segregated. CONCLUSION: Despite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics, but also when implementing permanent changes to care provision in primary care.

Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study.

The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0-23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.

Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium.

INTRODUCTION: Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID-19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented. METHODS: From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (<1%, 1-4.9% and ≥5%) and country income levels. RESULTS: Questions about pandemic-related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low- (n = 57), lower-middle (n = 79), upper-middle (n = 39) and high- (n = 50) income countries. Most sites reported being subject to pandemic-related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID-19 services, record-keeping interruptions and suspension of partner support. Almost all sites in low-prevalence and high-income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high-prevalence and lower-income settings. Few sites in high-prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi-month dispensing of ART (95%) and designating community ART pick-up points (44%). While few sites (5%) reported stockouts of first-line ART regimens, 10-11% reported stockouts of second- and third-line regimens, respectively, primarily in high-prevalence and lower-income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings. CONCLUSIONS: While many sites in high HIV prevalence settings and lower-income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID-19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings.

Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review.

BACKGROUND: Cancer comprises a high burden on health systems. Performance indicators monitoring cancer outcomes are routinely used in OECD countries. However, the development of process and cancer-pathway based information is essential to guide health care delivery, allowing for better monitoring of changes in the quality of care provided. Assessing the changes in the quality of cancer care during the COVID-19 pandemic requires a structured approach considering the high volume of publications. This study aims to summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020) in OECD countries and to assess changes in the quality of care as reported via selected indicators. METHODS: Search conducted in MEDLINE and Embase databases. Performance indicators and their trends were collated according to the cancer care pathway. RESULTS: This study included 135 articles, from which 1013 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic (n = 30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures (n = 64, 58%) and diagnoses (n = 130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed increasing trends (n = 8, 89% and n = 14, 56%, respectively). A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators (n = 9), and 70% (n = 43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79%(n = 82) of indicators concerning surgeries, 72%(n = 41) of indicators assessing radiotherapy, and 93%(n = 40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64%(n = 195) of indicators revealed changes in treatment. CONCLUSIONS: This study provides a summary of performance indicators used in the literature to assess the cancer care pathway from January 2020 to June 2020 in OECD countries, and the changes in the quality of care signalled by these indicators. The trends reported inform on potential bottlenecks of the cancer care pathway. Monitoring this information closely could contribute to identifying moments for intervention during crises.

Barriers and facilitators to the use of personal information documents in health and social care settings for people living with dementia: A thematic synthesis and mapping to the COM-B framework.

INTRODUCTION: People living with dementia experience communication difficulties. Personal information documents, or healthcare passports, enable communication of information essential for the care of a person with dementia. Despite the potential for providing person-centred care, personal information documents are not ubiquitously used. The Capability Opportunity Motivation-Behaviour (COM-B) model can be used to understand factors determining individuals' behaviours. OBJECTIVES: This study aimed to identify the barriers to and facilitators of the use of healthcare passports for people living with dementia through a systematic review methodology. METHODS: A systematic search of six electronic databases was undertaken. Grey literature was searched using three databases. All study types reporting barriers to or facilitators of the use of personal information documents in the care of adults living with dementia in high-income countries were included. Study quality was assessed using the NICE Quality Appraisal Checklist. Thematic synthesis was used to develop descriptive themes, which were subsequently mapped to the COM-B framework. RESULTS: Nineteen papers were included. Themes included training, awareness, embedding the process in norms and appreciating the value of the personal information documents. A broad range of barriers and facilitators was identified within each COM-B domain. CONCLUSION: This framework provides a starting point for evidence-informed initiatives to improve the use of personal information documents in the care of people with dementia. PATIENT AND PUBLIC CONTRIBUTION: This is a review of studies and did not involve patients or the public. Review results will guide evaluation of a local personal information document, which will be designed with input from the Dementia Champions Network (includes carers and other stakeholders).

Improving the quality and content of discharge summaries on acute medicine wards: a quality improvement project.

Discharge summaries are important medical documents that summarise a patient's hospital admission. The Royal College of Physicians provides standardised guidance on the content of discharge summaries, given their important role as a handover document to general practitioners (GPs). Our project started in June 2020 on an acute medical ward, where significant variation had been noted in the quality and content of discharge summaries. A multidisciplinary team (MDT) was formed including doctors, nurses and hospital/community pharmacists, as well as a patient representative, to ensure active patient co-design. The problem was scoped by asking GPs to provide feedback via surveys and process mapping. Our aim was to increase the compliance of discharge summaries with 10 core criteria from a baseline of 55% to 95% by June 2021. Change ideas were developed by the MDT and were tested using plan-do-study-act (PDSA) cycles that included additional pharmacy support, a discharge summary template and individualised feedback. The project reached its goal of 95% compliance in January 2021, 5 months ahead of the target date, and this improvement has been sustained since. The project expanded to a second acute medical unit ward in May 2021. The expanded project reached its goal of 90% compliance within 6 weeks and maintained sustained improvement with further PDSA cycles. A standard operating procedure has been created to help embed the changes on these wards. Our future aims are to redesign and improve the current electronic system and to help spread positive changes throughout the Trust.

Gaps in the continuum of care among people living with HIV in Afghanistan.

BACKGROUND: Afghanistan adopted a "test and treat" strategy for all people living with HIV (PLWH) in 2016. In this study, we presented demographic and clinical characteristics of all people diagnosed between 2013 and 2019 and evaluated progress towards 90-90-90 UNAIDS targets and identified program gaps among PLWH in Afghanistan diagnosed in 2018. METHODS: We used clinical, behavioral, and demographic data from national HIV surveillance for 1394 patients diagnosed from 2013 through 2019. We also tracked 184 patients diagnosed with HIV in 2018 over 15 months to assess their enrollment in care, antiretroviral therapy (ART) initiation, retention on ART, and viral suppression. RESULTS: Of 1394 patients diagnosed from 2013 through 2019, 76.0% were male, 73.7% were older than 24 years, and 33.4% acquired HIV through heterosexual sex. Of the 184 patients diagnosed in 2018, 94.6% were enrolled in care, 88.6% received ART, 84.2% were retained on ART for at least 12 months, and 33.7% received a viral load test. Of those with a viral load test, 74.2% were virally suppressed. Patients who were 35-44 years old (52.0%, p-value .001), acquired HIV through unsafe injection (62.5%, p-value .413), were co-infected with hepatitis C virus (HCV) (60.0%, p-value .449), and with CD4 > 500 at diagnosis (64.7%, p-value .294) were less likely to be virally suppressed 12 months after diagnosis. CONCLUSION: Nearly 95% of people diagnosed with HIV in Afghanistan in 2018 were linked to care and nearly 90% were on ART. Viral testing and viral suppression remain low with notable disparities for middle-aged patients, and possibly for those who injected drugs. Addressing barriers to HIV programs in Afghanistan, particularly for people who inject drugs (PWID), are urgently needed to reach the 90-90-90 global targets. Surveillance data on the number of people with undiagnosed HIV is needed to assess the first 90 target.

The Impact of the COVID-19 Pandemic on Hospital Services for Patients with Cardiac Diseases: A Scoping Review.

This study aims to assess the impact of the COVID-19 pandemic on hospital cardiac care, as assessed by performance indicators. Scoping review methodology: performance indicators were extracted to inform on changes in care during January-June 2020. Database searches yielded 6277 articles, of which 838 met the inclusion criteria. After full-text screening, 94 articles were included and 1637 indicators were retrieved. Most of the indicators that provided information on changes in the number of admissions (n = 118, 88%) signaled a decrease in admissions; 88% (n = 15) of the indicators showed patients' delayed presentation and 40% (n = 54) showed patients in a worse clinical condition. A reduction in diagnostic and treatment procedures was signaled by 95% (n = 18) and 81% (n = 64) of the indicators, respectively. Length of stay decreased in 58% (n = 21) of the indicators, acute coronary syndromes treatment times increased in 61% (n = 65) of the indicators, and outpatient activity decreased in 94% (n = 17) of the indicators related to outpatient care. Telehealth utilization increased in 100% (n = 6). Outcomes worsened in 40% (n = 35) of the indicators, and mortality rates increased in 52% (n = 31). All phases of the pathway were affected. This information could support the planning of care during the ongoing pandemic and in future events.

Cancer Australia consensus statement on COVID-19 and cancer care: embedding high value changes in practice.

INTRODUCTION: Driven by the need to reduce risk of SARS-CoV-2 infection and optimise use of health system resources, while maximising patient outcomes, the COVID-19 pandemic has prompted unprecedented changes in cancer care. Some new or modified health care practices adopted during the pandemic will be of long term value in improving the quality and resilience of cancer care in Australia and internationally. The Cancer Australia consensus statement is intended to guide and enhance the delivery of cancer care during the pandemic and in a post-pandemic environment. This article summarises the full statement, which is available at https://www.canceraustralia.gov.au/covid-19/covid-19-recovery-implications-cancer-care. MAIN RECOMMENDATIONS: The statement is informed by a desktop literature review and input from cancer experts and consumers at a virtual roundtable, held in July 2020, on key elements of cancer care that changed during the pandemic. It describes targeted strategies (at system, service, practitioner and patient levels) to retain, enhance and embed high value changes in practice. Principal strategies include: implementing innovative models of care that are digitally enabled and underpinned by clear governance, policies and procedures to guide best practice cancer care; enabling health professionals to deliver evidence-based best practice and coordinated, person-centred cancer care; and empowering patients to improve health literacy and enhancing their ability to engage in informed, shared decision making. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT: Widespread adoption of high value health care practices across all levels of the cancer control sector will be of considerable benefit to the delivery of optimal cancer care into the future.

Living with an ever-present breathlessness: Women's experiences of living with chronic obstructive pulmonary disease stage III or IV.

BACKGROUND: Living with chronic obstructive pulmonary disease stage III or IV has a major impact on a person's everyday life. This qualitative study focuses on women with chronic obstructive pulmonary disease stage III or IV. AIM: The aim of this study was to describe women's experiences of living with chronic obstructive pulmonary disease stage III or IV. METHOD: A purposive sample of fifteen women with chronic obstructive pulmonary disease stage III or IV participated in the study. Data were collected through individual semi-structured interviews that were subjected to qualitative content analysis. FINDINGS: One theme was identified, stabilizing an ever-present breathlessness by restoring strength, and three categories are as follows: managing a restricted everyday life as an expert of their illness, being afraid of contracting infections leading to suffocation and suffering and importance of continuous help and support from significant others and digital media. Breathlessness restricted women with chronic obstructive pulmonary disease, living with a body they have to wait for. Managing everyday life was adapted to their limited abilities and energy. This required detailed planning, good knowledge of their breathing and body. Women were afraid of contracting life-threatening infections that caused suffering, especially COVID-19. The fear leads to isolation and digital media was described as an important means of communication. Significant others gave support and help that was practical and emotional. Women with chronic obstructive pulmonary disease experienced lack of continuous help and support from healthcare professionals. CONCLUSION: Stabilizing an ever-present breathlessness by restoring strength required women with chronic obstructive pulmonary disease stage III or IV to conduct detailed planning to manage everyday life. Being afraid of contracting infections and the consequences of suffocation had increased since the pandemic COVID-19 outbreak, which led to self-isolation and an inactive everyday life. To get help, support and socialize, women used digital media.