Patient Preferences for Lung Cancer Interception Therapy

Objectives: Interception therapy requires an individual to take a treatment today to prevent a future medical event. Patients must trade off treatment burdens incurred today against future benefits. We examined the preferences of high-risk lung cancer (LC) individuals for potential interception therapies that reduce the risk of developing lung cancer. Method(s): An online discrete-choice experiment (DCE) was developed for hypothetical LC interception treatments with four attributes: reduction in risk of LC over 3 years, injection site reaction severity, nonfatal serious infection risk, and death from serious infection risk. Respondents chose between two alternative treatments or a no-treatment option. The DCE was analyzed using random-parameters logit, and maximum acceptable risk for an LC risk reduction was calculated. Logit analysis explored characteristics of respondents who always selected no treatment. Result(s): The sample included 803 adults aged 50-80 years with at least a 20 pack-year smoking history. Respondents had an average willingness to accept interception therapy (alternative-specific constant=1.30, 95% CI: 0.91-1.69). Respondents viewed larger reductions in the risk of LC as most important. Respondents were willing to accept increases in risk of nonfatal serious infection up to 15% for a 15% improvement in relative LC risk reduction and increases in risk of death from serious infection up to 1.5% for a 23% improvement in relative LC risk reduction. However, 16% of respondents selected 'no treatment' for all DCE questions. Older respondents, current smokers who have never tried to quit, and those who did not get regular skin exams for cancer and/or COVID-19 vaccine were more likely to opt out of interception therapy. Conclusion(s): Generally, individuals at high risk of LC are willing to consider interception therapy. Study results can support benefit-risk assessments for future systemic LC interception treatments, and the results may have implications for other therapeutic areas.Copyright © 2023

Use of technology to facilitate recovery in young adults with first-episode psychosis

Aims: Accessibility and engagement to high quality non pharmacological interventions for First-Episode Psychosis individuals (FEP) is hindered by different factors such as patients motivation, clinical time, lack of adaptation to patient needs. Taking into account patients' preference in the design in an individualized treatment plan as well as challenges faced by this particular patient, and his specific context/ environment can possibly enhance patient satisfaction and engagement. Technology can help to both standardized and individualize intervention to maximize the proposed services impacts. Method(s): This symposium explore how different technological tools can assist both clinicians and patients in enhancing patient experience of care First, the technokinpep, an innovative telekinesiology project offered by a peer support worker in multiple early psychosis services simultaneously, maximized accessibility of physical activity during the COVID-19 pandemic, social distanciation requirements. Second, Ocean empire, a mobile app aimed at improving physical activity motivation and affect in early psychosis. With this study, this presentation will shed light on the development and implementation of this mobile app. Third, exercise your wau used a mobile app to tailor the physical activity intervention program to the patients preferences and needs. Finally, the Freedom app gives the duo patient-clinicians a tool to facilitate shared decision making to enhance the therapeutic relation. Result(s): These different technologies can enhance patient and clinicians experience of collaborative and tailored adapted treatment. Conclusion(s): The development of new technology can help improving care by adapting it to better individual's needs.

Estimation of Intangible Costs for Factors Associated with Oral Antiviral Drugs for COVID-19 Treatment: A Conjoint Analysis in Japan.

INTRODUCTION: During the recent coronavirus disease 2019 (COVID-19) pandemic, preferences for factors associated with vaccines have been evaluated. Three oral antiviral drugs have been approved in Japan for patients with mild-to-moderate I COVID-19 symptoms. Although preferences for the drugs may also depend on various factors, these have not been fully evaluated. METHODS: A conjoint analysis was performed based on an online survey in August 2022 to estimate the intangible costs of factors associated with oral antiviral drugs for COVID-19. Respondents were individuals aged 20-69 across Japan. The attributes included the company (Japanese/foreign) that developed the drug, formulation and size of the drug, frequency of administration per day, number of tablets/capsules per dose, number of days until no longer infectious to others, and out-of-pocket expenses. A logistic regression model was applied to estimate the utility of each level for each attribute. The intangible costs were calculated by comparing the utility to the out-of-pocket attribute. RESULTS: Responses were collected from 11,303 participants. The difference between levels was the largest for companies that developed a drug; the intangible costs were JPY 5390 higher for the foreign company than for the Japanese company. The next largest difference was in the number of days until one is no longer infectious. For the same formulation, the intangible cost was lower for small sizes than large sizes. For similar-sized tablets and capsules, the intangible cost was lower for tablets than capsules. These tendencies were similar regardless of COVID-19 infection history and the presence of risk factors for severe COVID-19 in the respondents. CONCLUSION: Intangible costs for factors associated with oral antiviral drugs among the Japanese population were estimated. The results may change as the number of people with a history of COVID-19 infection increases and significant progress is made regarding treatments.

"A disembodied voice over the telephone": a qualitative study of healthcare practitioners' experiences in geriatric medicine.

OBJECTIVES: This study explored the experience of delivering care remotely among practitioners in a UK geriatric medicine clinic. METHODS: Nine semi-structured interviews were conducted with consultants (n = 5), nurses (n = 2), a speech and language and an occupational therapist, and thematically analysed. RESULTS: Four themes developed; Challenges of remote consultations; Perceived advantages of remote consultations; Disruption of involvement of family members; Impact on care staff. Participants felt that rapport and trust had been more feasible to develop remotely than they had anticipated, although this was more challenging for new patients and those with cognitive or sensory impairments. While practitioners identified advantages of remote consultations, including involving relatives, saving time, and reducing anxiety, they also experienced disadvantages such as consultations feeling like a 'production line', missing visual cues and reduced privacy. Some participants felt their professional identity was threatened by the lack of face-to-face contact, linked to feeling that remote consultations are not suitable for frail older adults or those with cognitive deficits. DISCUSSION: Staff perceived barriers to remote consultations that went beyond practical concerns, and suggest support for building rapport, involving families, and protecting clinician identity and job satisfaction may be warranted.

The "Zoom Boom" of the Covid-19 Pandemic Was Ironically Linked to Body Procedures

Purpose of Study: Cosmetic surgery preference is a highly individual choice. However, societal factors may influence public preference resulting in certain surgeries becoming more popular during a particular time. During the COVID-19 pandemic, many factors emerged which may have influenced patient decision making. These include increased time at home, hospital closure, increased time on social media, and the release of stimulus checks. Google Trends generates user search data for specific inquiries and thus is useful in reporting trends in plastic surgery related searches. The purpose of this study to determine whether the COVID-19 pandemic resulted in increased interest in certain surgeries over others. Methods Used: Google Trends was used to obtain user search data from June 2018 to June 2022. The data was obtained through entering common surgical procedure names, as well as general plastic surgery related inquiries. Special attention was given to when terms "peaked". This was then compared to the average trend of all searches and to the COVID-19 pandemic in general. Summary of Results: On average, early during the pandemic searches went down, seen as a prominent dip around March 2020. They then went up in June and July of the same year and stayed constant until early 2021. There was then a marked increase in March of 2021, with subsequent months maintaining a high percentile of search interest. This peak coincided with the third and final stimulus check release, a total of 3200 USD over the three checks, with the third being the largest (1400 USD). Of the terms analyzed, surgeries related to body contouring appeared to peak around the same time, most often in the period of March-July of 2021. Terms related to facial procedures peaked either before or after this period. Conclusion(s): The results suggest that the "boom" seen in the average trendline was predominately due to body contouring procedures. While it is difficult to determine what exactly caused this phenomenon, it is hypothesized that increased time at home, decreased physical activity, as well as the release of stimulus checks may have resulted in a patient preference for body contouring over facial procedures. Further research could focus on real practice patient numbers by procedure, and thus determine if the trends reported by Google follow real patient preference.

Imperial Prostate-4 Comparative Healthcare Research Outcomes of Novel Surgery in Prostate Cancer (Ip4-Chronos): Early Feasibility, Safety and Functional Outcomes from a Pilot Rct

INTRODUCTION AND OBJECTIVE: Randomised comparative outcomes are unavailable for focal therapy in localised prostate cancer. IP4 CHRONOS is an RCT aimed to optimise recruitment of patients dependent upon clinician and patient equipoise. METHOD(S): Patients with clinically significant localised prostate cancer could opt for IP4-CHRONOS-A or IP4-CHRONOS-B. IP4- CHRONOS-A randomised patients 1:1 between focal therapy(HIFU or cryotherapy) versus radical therapy(radiation or prostatectomy). Using a multi-arm-multistage(MAMS)design, IP4-CHRONOS-B randomised between focal alone(FTA) and focal combined with neoadjuvant medication (12 weeks of finasteride [FTF] or bicalutamide [FTB]). We report the pilot phase outcomes on feasibility of randomisation, early safety outcomes relative to treatment and genito-urinary functional outcomes following over 12 months treatment in IP4-CHRONOS-B. IP4-CHRONOS had ethics committee approval and was registered(ISRCTN17796995). RESULT(S): Following COVID-19 adjustments, IP4-CHRONOSA did not meet its feasibility target. Having randomised 36 patients via10 sites with a recruitment rate (95% CI) of 18% (13-23) & randomisation rate of 97%(86-100). IP4-CHRONOS-B did meet its target, randomising 64 patients across 7 sites with a recruitment rate of 43% (35-52) &randomisation rate of 100%(94-100). The only patients to withdraw were randomised to the radical arm of IP4-CHRONOS-A(4 [22%]) All patients in IP4-CHRONOS-B were compliant with neoadjuvant treatment.Only 1 patient reported CTCAE V4.0 grade>=3 adverse event(AE) in IP4-CHRONOS-A following radical treatment, another patient in each arm reported a serious adverse event(SAE) following treatment. 1 &3 patients reported an AE &SAE following FTB. 2 and 3 patients reported an AE &SAE following FTA. No patients reported any AE or SAE event following FTF. Figure 1 demonstrates generally well preserved genito-urinary function following focal treatment+/-neoadjuvant treatment. CONCLUSION(S): IP4-CHRONOS evaluated patient and physician equipoise regarding focal therapy. Traditional randomisation was not feasible due to strong patient preferences, while a MAMS RCT investigating the role of neoadjuvant agents combined with focal therapy was.

Lung cancer patients' views on screening and experiences of treatment and care - findings from the Global Lung Cancer Coalition's third annual global survey

Introduction: In 2022, the Global Lung Cancer Coalition (GLCC), a partnership of 42 patient organisations across 30 countries, ran its third annual global patient experience survey on the continued impact of COVID-19 on people living with lung cancer. Method(s): A steering group of patients, advocates, and clinicians developed the survey, asking questions around screening, patients' involvement in decision-making, and preferences in speaking to their treatment team. 555 patients from 21 countries responded, including 83 from the UK and Ireland. [Figure presented] Results: The results show that all responding patients in Ireland and 9 in 10 in the UK would attend a screening appointment if it was available and they were invited. Only a small proportion said they would not attend, and a minority were unsure. When asked if they have been involved in decisions about their treatment and care, a large proportion of patients in both countries stated they have not felt fully involved. The majority of patients in the UK and Ireland prefer speaking to their treatment team in person in a range of situations. However, if patients are worried about something, they would be willing to have a telephone conversation with their treatment team. Conclusion(s): The findings on screening are encouraging given the National Screening Committee's recent recommendation to implement a targeted screening programme in the UK. In Ireland, advocacy organisations continue to lobby the Government for a national programme, and it is positive to see high levels of patient support. Treatment teams should be asking and supporting patients to be as involved in decisions around their treatment and care as they wish to be. Finally, it is clear that patients prefer to discuss their treatment and care face-to-face. Treatment teams should seek to understand patients' preferences, and health systems should put in place relevant provisions to offer virtual appointments. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Providing choice in pulmonary rehabilitation

Introduction/Aim: Pulmonary rehabilitation (PR) is a vital component in the management of chronic respiratory disorders (CRDs). New models of delivering PR are emerging to increase the uptake and completion of this important intervention. The aim of this study is to evaluate participant rate of attendance to PR delivered via two different delivery modes (centre based and mobile technology (mPR)). Secondary aims are to evaluate the patient preference for mode of delivery, and if mPR is non -inferior to centre-based PR in health outcomes. Method(s): A multi-centre, two-arm parallel preference based clinical trial was conducted. Participants with a chronic respiratory disorder referred for PR were offered the choice of centre-based or web-based (mPR) PR. Both programmes were 8 weeks in duration. The primary outcome was attendance. Result(s): 105 participants were recruited to the study with 67 opting for centre-based and 38 preferring web-based PR (mPR). The attendance rate was higher in the centre-based group than mPR. Results showed mPR was not inferior in terms of changes in symptom scores (CAT) or time spent in sedentary behaviour (SBQ) but inferiority could not be confirmed for changes in dyspnoea scores (mMRC) or health related quality of life (EQ5D-3L). Changes in exercise capacity could not be determined due to COVID-19 restrictions. Conclusion(s): This pragmatic study has shown that mPR was preferred by 38% of participants and a significant percentage were younger, working, with higher education inferring the demand will likely increase over time. The attendance rate with mPR was lower than anticipated. Further research with larger sample size is required to assess efficacy of mPR.

The Selah study protocol of three interventions to manage stress among clergy: a preference-based randomized waitlist control trial.

INTRODUCTION: Like many helping professionals in emotional labor occupations, clergy experience high rates of mental and physical comorbidities. Regular stress management practices may reduce stress-related symptoms and morbidity, but more research is needed into what practices can be reliably included in busy lifestyles and practiced at a high enough level to meaningfully reduce stress symptoms. METHODS AND ANALYSIS: The overall design is a preference-based randomized waitlist control trial. United Methodist clergy in North Carolina will be eligible to participate. The intervention and waitlist control groups will be recruited by email. The interventions offered are specifically targeted to clergy preference and include mindfulness-based stress reduction, Daily Examen, and stress inoculation training. Surveys will be conducted at 0, 12, and 24 weeks with heart rate data collected at 0 and 12 weeks. The primary outcomes for this study are self-reported symptoms of stress and heart rate at week 12 for each intervention compared to waitlist control; the secondary outcome is symptoms of anxiety comparing each intervention vs waitlist control. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Duke University Campus IRB (2019-0238). The results will be made available to researchers, funders, and members of the clergy community. STRENGTHS AND LIMITATIONS OF THIS STUDY: While evidence-based stress reduction practices such as mindfulness-based stress reduction (MBSR) exist, a wider variety of practices should be tested to appeal to different individuals. Clergy in particular may prefer, and consequently enact, spiritual practices like the Daily Examen, and individuals such as clergy who spend most of their time thinking and feeling may prefer experiential-based practices like stress inoculation training. If efficacious, the Daily Examen and stress inoculation training practices have high feasibility in that they require few minutes per day. This study is limited by the inclusion of Christian clergy of only one denomination. TRIAL REGISTRATION: ClinicalTrials.gov NCT04625777 . November 12, 2020.

Patient preferences for telehealth services in a large multispecialty practice.

INTRODUCTION: Telehealth service provision has accelerated during the Coronavirus disease 2019 (COVID-19) pandemic. As the pandemic continues, clinical practices have discovered ways to resume operations. Opportunities exist to understand patient preferences for telehealth clinical services and to tailor offerings to different demographic groups. METHODS: We conducted a survey of patients receiving telehealth services through our outpatient practice to understand the types of healthcare services for which patients report preferences for telehealth. RESULTS: We received 551 survey responses (response rate = 20.8%; 551/2650). More than half of patients indicated being 'very likely' to use telehealth services to refill medication(s) (67.3%), prepare for an upcoming visit (66.1%), review test results (60.3%), or receive education (54.2%). Males had lower odds of preferring telehealth services for reviewing test results (odds ratio (OR) = 0.57; 95% confidence interval (CI): 0.34-0.94) or mental health issues (OR = 0.54; 95% CI: 0.38-0.77). Respondents who received a video visit were significantly more likely than those who received a telephone visit to report preferences for using telehealth for education, care plan discussions, long-term health issues, and mental health. DISCUSSION: Patient preferences for telehealth services vary by services provided and respondent demographics. Experience with telehealth increases the likelihood for future use of these services.

THE USE OF LONG-ACTING INSULIN DEGLUDEC IN ADULT PATIENTS WITH TYPE 2 DIABETES MELLITUS IN REAL CLINICAL PRACTICE IN RUSSIA.

BACKGROUND: Effective glycaemic control remains the most important task in managing the risks of Diabetes type 2 complications development. In this regard, the choice of insulin preparations with minimal variability of action is of utmost importance since this approach allows achieving the maximum treatment effectiveness and adequate safety level. AIM: The aim of this study was to investigate insulin degludec treatment effect on glycemic control in adult patients with Diabetes Mellitus (DM) type 2 in a real-world clinical setting in the Russian Federation. MATERIALS AND METHODS: The open prospective study was conducted in 2020-2021 in 35 clinical centers in 31 cities of the Russian Federation. The study included adult patients with type 2 DM treated according to Russian routine clinical practice. The prospective follow-up period was 26 weeks. The main study endpoints were changes in HbA1c level, fasting plasma glucose, insulin daily doses, number, and characteristics of different types of hypoglycaemia episodes and adverse events (AEs), and patient preferences compared to previous treatment. RESULT(S): The study enrolled 494 patients. By the end of follow-up period: * The mean HbA1c decrease was 1.6% (p<0.0001). * Fasting plasma glucose level decreased by 3.4 mmol/L (p<0.0001). * Daily basal and prandial insulin doses decreased by 1.6 IU/day (p<0.0001) and 2.1 IU/day (p<0.01), respectively. * Severe episodes of hypoglycemia did not occur, while the incidence of nonsevere episodes decreased significantly. * 76 patients (15.4%) had 105 AEs, of which 41 (in 33 patients, 6.7%) were serious. * COVID-19 was the most frequent AE reported in 21 patients (4.3%). * Only in one case insulin degludec was withdrawn due to the patient's pregnancy and the AEs that arose from it. * Most patients (98.6%) preferred insulin degludec to previous treatment. CONCLUSION(S): The study demonstrated a statistically significant improvement in glycemic control, accompanied by basal insulin dose decrease combined with the absence of severe episodes of hypoglycemia, and significant decrease of nonsevere episodes (total and nocturnal). These results led to a large proportion of patients wanting to continue insulin degludec treatment preferring the medicine over previous treatment.Copyright © 2023 Russian Association of Endocrinologists. All rights reserved.

Is a hybrid skin cancer surveillance service for organ transplant recipients feasible? Lessons from the pandemic

Organ transplant recipients (OTRs) are highly vulnerable to SARS-CoV-2 infection and routine transplant consultations were converted primarily to virtual (VC) rather than face to face (F2F) from the outset of the pandemic. A similar strategy was adopted in our tertiary OTR dermatology clinic, but the implications of this on safe and effective skin cancer surveillance are uncertain. We audited clinical and patient experiences of our hybrid service with the aim of identifying the benefits and limitations of this approach, and improvements required to optimize a future hybrid VC-F2F model for skin cancer surveillance. All OTRs consultations held between 1 April 2020 to 31 March 2021 were identified through electronic patient records. Data collected included proportions and reasons for VC and F2F consultations, teledermatology requests, VC to F2F conversion rate, rates of skin cancer diagnoses and adherence to established follow-up protocols. All patients were invited to complete an online service evaluation. In total, 554 encounters (80.3% VC, 19.7% F2F) were recorded in 247 OTRs (42% with previous skin cancer). Of routine F2F consultations, this was patient preference in 17 of 109 (16%) and clinician-based risk assessment for the remainder. In 108 (25%) VCs, photographs were requested and received for 63%, of which 82% were adequate for diagnosis. Overall, 12% of VCs were converted to F2F and in 19 of 45 (42%) OTRs this was due to suspected skin cancer, which was confirmed in nine of 19 (47%). All other skin cancers were diagnosed in routine F2F consultations. Surveillance in 167 of 192 (87%) assessable OTRs adhered to established follow-up protocols. Of patients who responded to the online survey, 74% felt that there were benefits to VCs, but 41% expressed concern about the lack of skin examination and 57% reported little/no confidence in self-monitoring. Despite this, 59% expressed a preference to continue hybrid VC-F2F surveillance, with VC as routine and F2F consultation when required. Our audit provides preliminary evidence supporting the effectiveness, safety and patient acceptability of a VC-F2F hybrid model for the delivery of OTR skin cancer surveillance. We did not identify major delays in skin cancer diagnosis, although not all patients have yet been seen F2F. Certain aspects of service delivery will require optimization. In particular, despite routine skin cancer education, many patients expressed concerns about self-monitoring. Programmes specifically tailored to address this need will be required, as will information technology support for some OTRs. With this information we are redesigning our service to incorporate a VC-F2F model for routine skin cancer surveillance and are evaluating the incorporation of a patient-initiated follow-up pathway.

Trends and Predictors of Short Wait Time for Transcatheter Aortic Valve Replacement in a Rural Health Care Network

Background Prolonged wait times for Transcatheter Aortic Valve Replacement (TAVR) are associated with increased mortality. Rural health care systems may have challenges in efficiency due to travel related delays. We determined temporal trends and predictors of Short TAVR Wait Time (STWT: TAVR <=30 days from first referral). Methods We identified 918 consecutive patients with Aortic Stenosis (AS) undergoing TAVR from 1/1/19-6/30/22 at a rural tertiary care center. Patients with wait times?>90 days (N=87) were excluded due to patient preferences or treatment of comorbidities. We assessed TAVR wait times (means and STWT%) over time and determined the impact of COVID 19 onset (3/1/20) and driving distance on TAVR efficiency. Results Half of the cohort achieved STWT (51%). TAVR volumes, patient age, sex, and comorbidities were generally stable over time. Mean wait times decreased despite the onset of COVID 19: pre-COVID 36+/- 19 vs post-COVID 31+/- 19 days (p=0.003) (Figure). There was no interaction of travel distance and mean wait time: 33+/- 19 days <= 60 miles vs 32+/- 19 days?> 60 miles (P=NS). Conclusion TAVR efficiency improved over the past 4 years with one half of patients experiencing a STWT. Neither COVID 19 nor long travel distance negatively impacted TAVR efficiency in a rural health care network. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

SMALL: Open Surgery versus Minimally invasive vacuum-Assisted excision for smaLL screendetected breast cancer - a UK phase III randomised multicentre trial

Background: Mammographic screening programmes reduce breast cancer mortality, but detect many small tumours with favourable biological features which may not progress during a woman's lifetime. Screen-detected cancers are treated with standard surgery and adjuvant therapies, with associated morbidities. There is a need to reduce overtreatment of good prognosis tumours and numerous studies have evaluated the omission of radiotherapy in this context. However, there is little evidence to support surgical de-escalation, although percutaneous minimally invasive treatment approaches have been described. Vacuum-assisted excision (VAE) is in widespread use for management of benign lesions and lesions of uncertain malignant potential. SMALL (ISRCTN 12240119) is designed to determine the feasibility of using this approach for treatment of small invasive tumours detected within the UK NHS Breast Screening Programme (BSP). Method(s): SMALL is a phase III multicentre randomised trial comparing standard surgery with VAE for screendetected good prognosis cancers. The main eligibility criteria are age >=47 years, unifocal grade 1 tumours with maximum diameter 15mm, which are strongly ER/PR+ve and HER2-ve, with negative clinical/radiological axillary staging. Patients are randomised 2:1 in favour of VAE or surgery;with no axillary surgery in the VAE arm. Completeness of excision is assessed radiologically, and if excision is incomplete, patients undergo open surgery. Adjuvant radiotherapy and endocrine therapy are mandated in the VAE arm but may be omitted following surgery. Co-primary end-points are: 1. Noninferiority comparison of the requirement for a second procedure following excision 2. Single arm analysis of local recurrence (LR) at 5 years following VAE Recruitment of 800 patients will permit demonstration of 10% non-inferiority of VAE for requirement of a second procedure. This ensures sufficient patients for single arm analysis of LR rates, where expected LR free survival is 99% at 5 years, with an undesirable survival probability after VAE of 97%. To ensure that the trial as a whole only has 5% alpha, the significance level for each co-primary outcome is set at 2.5% with 90% power. The Data Monitoring Committee will monitor LR events to ensure these do not exceed 3% per year. Secondary outcome measures include time to ipsilateral recurrence, overall survival, complications, quality of life and health economic analysis. A novel feature of SMALL is the integration of a QuinteT Recruitment Intervention (QRI), which aims to optimise recruitment to the study. Recruitment challenges are identified by analysing recruiter/patient interviews and audiorecordings of trial discussions, and by review of trial screening logs, eligibility and recruitment data and study documentation. Solutions to address these are developed collaboratively, including individual/group recruiter feedback and recruitment tips documents. Result(s): SMALL opened in December 2019, but recruitment halted in 2020 for 5 months due to COVID-19. At 7st July 2022, 142 patients had been randomised from 26 centres, with a randomisation rate of approximately 45%, and a per site recruitment rate of 0.4-0.5 patients/month, approaching the feasibility recruitment target of 144 patients. Drawing from preliminary QRI findings and insights from patient representatives, a recruitment tips document has been circulated (on providing balanced information about treatments, encouraging recruiters to engage with patient preferences, and explaining randomisation). Individual recruiter feedback has commenced, with wider feedback delivered across sites via recruitment training workshops. Conclusion(s): Despite pandemic-related challenges, SMALL has an excellent recruitment rate to date and is expected to have a global impact on treatment of breast cancer within mammographic screening programmes.

Patient satisfaction and patient costs associated with telephone clinic appointments in Inflammatory Bowel Disease (IBD) following the pandemic

Background: Prior to the COVID-19 pandemic, conventional management of outpatient care in IBD predominantly revolved around face-to-face clinic appointments. In the changing landscape of care provision during the pandemic, appointments were conducted almost exclusively through telephone consultation. An electronic questionnaire was developed to assess patient satisfaction and patient costs. Method(s): A pilot was carried out with 15 patients to identify any technical issues with e-mail delivery of the questionnaire and gauge face validity of the questionnaire content. 1400 patients registered with the TrueColours-IBD remote digital monitoring system were sent the questionnaire link via e-mail in May 2021. No demographic data were collected by design, in order to avoid the perception of bias and ensure freedom of expression through anonymity. Result(s): 506 responses were received including 21 duplicates which were excluded, totalling 485 valid responses. 408/485 patients reported having a telephone appointment with the IBD service since March 2020, 484/485 reported having had a face-to-face appointment in the past. 348/408 (86%) were either 'very satisfied' or 'somewhat satisfied' with their most recent telephone consultation, while 22 (6%) were either 'very dissatisfied' or 'somewhat dissatisfied'. 247/408 (61%) were also either 'very satisfied' or 'somewhat satisfied' with the ease of accessing further care if required, compared to 33/408 (8%) who were either 'very dissatisfied' or 'somewhat dissatisfied'. Given the choice, 195/408 (48%) patients preferred to receive a telephone appointment in the future;147/408 (36%) would opt for face-to-face and 66/408 (16%) stated no preference, all with the option of changing that choice if needed. Telephone appointments were associated with a mean total patient time off-work or leisure of 23 minutes (S.D. 51, n=408) compared to 190 minutes (S.D. 96, n=484) for face-to-face appointments. The average cost of time off work or leisure associated with telephone appointments was 5.55 (S.D. = 15.74, n=408), compared to 43.42 (S.D. = 31.27, n=484) for face-to-face appointments (Table 1). Costs of transport add further to face-to-face appointment costs. Greater proportions of patients had a companion for their face-to-face appointment and required childcare compared to telephone consultations (Table 2), which again increases the difference in costs. Conclusion(s): Almost half of surveyed patients stated a preference for telephone appointments, although a third still preferred traditional follow-up. An evolution of care pathways is supported by patient preference and the statistically significant time and cost savings to patients receiving telephone appointments. (Figure Presented).

Virtual Monitoring of Physical Activity in the Our Hearts Our Minds (Ohom) Cardiac Rehabilitation Programme Using a Cloud Based Dashboard

Background Cardiac rehabilitation is accessed by only ~50% of eligible patients. Virtual options have become more important since Covid. The Our Hearts Our Minds (OHOM) programme used wearable technology (Fitbit) for virtual physical activity monitoring. Aim To examine whether a Fitbit smartwatch/dashboard component was an acceptable option to improve physical activity levels in the absence of supervised exercise classes. Methods Initial multidisciplinary assessments were conducted via telephone/video as per patient preference. Patients were offered a Fitbit, if they did not have their own smartwatch and to synchronise to a cloud based dashboard visible to the clinical team. Using behaviour change techniques, tailored physical activity advice was provided including personalised notifications pushed to the patient's Fitbit app. Patients also received coaching calls and virtual group education sessions. Average daily step count and active minutes (over a 7 day period) were calculated at the start and end of programme. Results 1066 referrals were received from 01/04/20 to 30/ 03/22, of which 1043 patients (98%) had an initial assessment. Of these, 407 wore a Fitbit device (33% provided by programme, 6% own Fitbit) and synchronised to OHOM Fitbit dashboard (39% uptake). 6% had their own non-Fitbit smartwatch. 55% declined Fitbit (5% didn't own a smartphone for app download or access the internet, 3% weren't interested in technology, 2% medical reasons, 2% didn't collect, 43% weren't interested in virtual monitoring). Physical activity outcomes pre and post programme are shown in table 1. Conclusion Fitbit (and other) smartwatches coupled with centralised monitoring provided a viable alternative to supervised exercise classes in approximately half of those attending cardiac rehabilitation with evidence of increased physical activity.

Remote monitoring and virtual follow-up ventilation clinics in the age of Covid-19

Background: To review the efficacy of long-term non-invasive ventilation (LTV) with virtual follow-up, using assistive technologies and remote monitoring. Objective(s): Compliance greater than 4 hours, correction of hypercapnia and improvements in sleep and quality of life (QoL) were the objectives in improving patient outcome. Method(s): We conducted a retrospective cohort study including patients established on LTV over an 18 month period from the start of the pandemic. Initiation of LTV was established as an inpatient (n= 17;35%), outpatient (n= 28;57%) or from the patient's home (n= 4;8%) and follow-up was by telephone, video consultation or from the patient's own home. LTV was considered successful if compliance achieved was > 4 hours using remote monitoring, corrected hypercapnia (tCO2 < 6.5Kpa) and patient-reported improvements in sleep and QoL. Result(s): Forty-nine patients were included. LTV was initiated for: neuromuscular disease (n=19;39%), obesity hypoventilation or overlap (n=12;24%), chronic obstructive pulmonary disease (n=11;22%) and chest wall deformity (n=6;14%). Compliance > 4 hours was achieved in 69% with effective correction of hypercapnia (tCO2 < 6.5Kpa) in 67% and reported improved sleep and QoL at 63%. Overall success in all 3 objectives was 61%. Patient preference for future follow-up was 45% requesting face-to-face consultations and 33% to continue remotely. A proportion of the most vulnerable (14%) would prefer to be seen at home. Conclusion(s): Successful LTV can be achieved with remote compliance data and transcutaneous carbon dioxide monitoring to support virtual clinics. Patient preference for face-to-face consultations remains important in overall satisfaction.

Spanish multidisciplinary consensus on the characteristics of severe asthma patients on biologic treatment who are candidates for at-home administration

Background and objective: Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. Material(s) and Method(s): This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. Result(s): One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. Conclusion(s): Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.Copyright © 2022

Mapping UK rehabilitation provision for adults after hospital admission with COVID-19

Introduction: NICE guidance (2020) for Long Covid calls for a comprehensive assessment and, where appropriate, referral to rehabilitation. Our aim was to explore characteristics of rehabilitation programmes (RP) for patients in the UK. Method(s): Rehabilitation specific information was extracted from a survey of sites taking part in the PHOSP-COVID study (https://www.phosp.org/), Feb 2020-Mar 2021. Data included professions and services involved, content, outcome measures and model used. Data was recorded on JISC and exported to Excel. Result(s): 32/45 sites had access to RP, half was covid specific RP. 22 provided content information. Most RP were delivered by the same organisation providing post-hospitalisation review, 19/22 used more than one model of delivery. Models included face to face, virtual, digital platforms and home-based models. Decisions on how to deliver RP depended on available staff, service pressures, safety and patient preference. RPs delivered most often by Allied Health Professionals and existing Pulmonary Rehabilitation services (16 services), 3 single profession. Not all RPs matched outcome measures to components delivered, Figure1. Conclusion(s): 2/3rds of sites were able to access either covid or non-covid specific MDT rehabilitation. There is heterogeneity in the assessment and content of rehabilitation delivered, as well as the model of delivery.