Background Asthma is misdiagnosed in one-third of patients. Due to its variable nature, international guidelines recommend performing key diagnostic tests during symptomatic periods or in the morning to improve accuracy. Limited access to timely clinic appointments and community-based diagnostics makes this difficult. Handheld spirometry and fractional exhaled nitric oxide (FeNO) are feasible for home use, enabling timely and flexible testing.Objective To explore patients’ views on performing spirometry and FeNO at home during the asthma diagnostic process.Design A qualitative study using semistructured interviews. Data were analysed using the framework approach.Setting This prospective observational study was conducted at a National Institute for Health and Care Research Clinical Research Facility, based within a large National Health Service Trust, as part of the Rapid-Access Diagnostics for Asthma (RADicA) study (ISRCTN11676160).Participants A purposive sample of 15 symptomatic adult patients with general practitioner-suspected asthma who were referred for diagnostic evaluation of the condition; all patients were given home spirometry and FeNO devices during their diagnostic processes.Results Three themes emerged from the analysis: ‘Perceived value of, and burdens of home testing’, ‘Views on device usability and acceptability’ and ‘Information and support needs’. Home testing was generally welcomed by patients as a way of improving their understanding of their condition and enabling an accurate diagnosis of their symptoms. Key barriers (eg, testing frequency, lack of privacy) and enablers to improve feasibility (eg, training and support) were also identified.Conclusion This study provides valuable insights into the barriers and enablers of home-based diagnostic strategies for asthma. Findings can inform service design and implementation approaches to enhance the feasibility and effectiveness of home testing.Trial registration number ISRCTN11676160.

Background Electronic patient-reported outcomes (ePROs) are commonly used in oncology clinical practice and have shown benefits for patients and health resource use. Objective The aim of this study was to compare the isolated effect of administering ePROs to patients with cancer versus a control condition. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Randomized controlled trials evaluating ePRO interventions that aimed to improve health-related outcomes among patients with cancer were included. The primary outcome was health-related quality of life (HRQOL), and the secondary outcomes were symptoms, hospital admissions, unplanned visits, chemotherapy completion, survival, and satisfaction with care. The effect sizes of ePROs on health-related outcomes were analyzed as standardized mean differences (SMDs) with 95% CIs using a random effects model. Results The search identified 10,965 papers, of which 19 (0.17%) from 15 studies were included. The meta-analysis showed an improvement in HRQOL at 3 months, measured by the Functional Assessment of Cancer Therapy–General (SMD 0.28, 95% CI –1.22 to 1.78), and at 6 months, assessed using various HRQOL measures (SMD 0.07, 95% CI –1.24 to 1.39). The results should be interpreted with caution, given the wide 95% CIs. Of the 15 studies, 9 (60%) reported a positive signal on HRQOL, with two-thirds of the studies (n=6, 67%) including tailored patient advice and two-thirds (n=6, 67%) using clinician alert systems. Conclusions The meta-analysis showed a potential improvement in HRQOL at 6 months and in Functional Assessment of Cancer Therapy–General scores at 3 months for studies that included tailored advice and clinician alerts, suggesting that these elements may improve ePRO effectiveness. The findings will provide guidance for future use and help health care professionals choose the most suitable ePRO features for their patients. Trial Registration PROSPERO CRD42020175007; https://tinyurl.com/5cwmy3j6

IntroductionCheckpoint inhibitors (CPI) are widely used across different tumour types in older cancer patients. The ELDERS study investigated primarily the safety of CPI in older patients, and secondarily its impact on health-related quality of life (HRQoL), comparing older and younger patients. Here we describe the results from its secondary aim.Materials and MethodsThis was an observational, mixed methods study, consisting of questionnaires and qualitative interviews. Patients completed the EORTC QLQ-C30 at baseline and at three-monthly reviews (up to four over the planned 12 months on study).ResultsOne hundred and forty patients, 70 in each age cohort (older: ≥70 years of age, younger: <70 years of age), were recruited. Twenty-four patients, 12 in each age cohort, were interviewed. The mean baseline EORTC QLQ-C30 score was 65/100 for both cohorts combined, and the score for the full QLQ-C30 assessment was 78/100 and 75/100 for older and younger, respectively. The physical functioning score was the only subscale to change significantly between baseline and the first and second reviews (p = 0.03 and 0.04, respectively), resulting from some improvement in the mean score (from baseline) within the younger cohort and some decline within the older cohort. However, when focusing on each cohort separately, the change over time was not statistically significant for either. Two main themes from the interviews were ‘expectations’ (thoughts about treatment before commencing) and ‘experience’ (lived experience during treatment).DiscussionQuantitatively, there was no difference in the effect of CPIs on HRQoL between the cohorts, although qualitative data from interviews suggested that there were some experiential differences. People in the older cohort were less likely to seek additional information about CPIs and were more likely to report side effects. In terms of both ‘expectations’ and ‘experience,’ the older cohort was a heterogenous group, highlighting that an individualised approach is needed when supporting this group. This study shows that older patients can be reassured that immunotherapy is unlikely to negatively impact their HRQoL more than younger patients, and it should be considered a viable treatment option.

Objectives A prospective cohort study to evaluate clinical effectiveness of the enhanced supportive care (ESC) service at a comprehensive cancer centre and to explore the impact of the service on patient and caregiver outcomes and experience. Methods Patients who received care under the ESC service and their caregivers were eligible. Consented patients (n=184) and caregivers (n=67) completed questionnaires at baseline, 4 weeks and 8 weeks post-ESC. Patient questionnaires assessed quality of life (QOL), symptoms, experience of ESC and health service use. Caregiver questionnaires included QOL and needs assessment. Selected patients (n=13) participated in qualitative interviews. Quantitative analysis explored differences in questionnaire responses over time (p<0.05). Qualitative data were analysed thematically. Results Patient quantitative data showed improvements in QOL (p=0.004 for European Quality of Life Questionnaire 5 dimensions (EQ5D) health index scores) and anxiety (p=0.006) at 4 weeks, reduction in some symptoms (pain p=0.02 at 4 weeks), improvement in self-efficacy, an increase in problems being addressed and a decrease in health service use (reduction in outpatient appointments). Qualitative findings suggested patients were generally satisfied with the ESC service but identified areas for improvement such as increased awareness of ESC and earlier referral. Fewer improvements were noted for caregivers; however, they did report a decrease in unmet needs. Conclusion The ESC service had a positive impact on various patient-reported and caregiver-reported outcomes. There were also positive impacts on health service use. Increasing awareness of ESC and engaging patients at an earlier stage in the disease trajectory may further improve patient satisfaction and outcomes.

Purpose The study explores experiences of lung cancer patients during COVID-19 and considers how changes to care delivery and personal lives affected patient needs. Methods Semi-structured telephone interviews were conducted to explore experiences of lung cancer patients during COVID-19. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Interview participants were purposively selected based on age, gender, treatment status, timing of diagnosis (pre/post first COVID-19 lockdown) from a sample of lung cancer patients (any histological subtype/any cancer stage/any point in treatment) who had completed a questionnaire exploring how participants’ lives were impacted by the pandemic and their thoughts on clinical care and remote communication. Results Thirty lung cancer patients who participated in the questionnaire study were approached and participated in an interview. Three themes were identified: (1) Adapting to new modes of communication (focusing on experiences of remote communication); (2) Experience of care delivery during the pandemic (describing how all aspects of care delivery had been affected); (3) Impact of the COVID-19 pandemic on quality of life (QOL) (focus on the psychological impact and feeling of reduced support). Themes 1 and 2 are heavily interlinked and both had bearing on patients’ QOL experience. Conclusion Lung cancer patients were impacted psychologically by changes to care delivery and changes in their personal life. The findings highlight some benefits to remote consultations but the stage of the treatment pathway and illness trajectory should be considered when determining if this is appropriate. Participants felt support from peers, family and friends was limited during the pandemic.

INTRODUCTION:Care Opinion is an online feedback platform supporting patients to author stories about their care. It is not known whether authors would be willing to be involved in improving care through research. The aims of this study were to explore the views and preferences of Care Opinion authors about joining an online research community and to pilot new research community functionality.METHODS:Five hundred and nine Care Opinion authors were invited to take part in an online survey in June 2019. Survey items included questions about participants' willingness to take part in research and their preferences for supporting processes. Data were analysed descriptively. Authors were invited to consent to join a research community and were asked to participate in three pilot studies.RESULTS:One hundred and sixty-three people consented to take part in the survey (32%). Participants indicated they would like to know the time commitment to the project (146, 90%), details about the organization carrying out the research (124, 76%) and safeguarding information (124, 76%). Over half indicated that they did not know how to get involved in healthcare research (87, 53%). Subsequently, 667 authors were invited to join the research community, 183 (27%) accepted, and three studies were matched to their expressed preferences for project attributes or organization type.CONCLUSION:Many people who leave online feedback about their experiences of healthcare are also willing to join a research community via that platform. They have strong preferences for supporting University and NHS research. Eligibility and acceptance rates to join pilot research studies varied. Further work is needed to grow the research community, increase its diversity, and create relevant and varied opportunities to support research.PATIENT OR PUBLIC CONTRIBUTION:Four members of the Safety In Numbers patient and public involvement and engagement (PPIE) group advised about survey development.

Introduction The impact of smartphone technology is changing the approach to learning and teaching in clinical dental education. The aim of this study was to understand the challenges, opportunities and attitudes that both dental undergraduate students in an English dental school and tutors experience when using electronic learning.Materials and methods Six faculty members and 20 students agreed to take part in semi- structured interviews. Topic question guides for the student interviews focused on searching for information and how they used mobile learning. Questions also asked about the barriers encountered when accessing information on the internet, their perspective on the term 'evidence-based' information, and their use of mobile apps. The question topic guide for faculty was similar, with an emphasis on their attitudes to the introduction of such technology in dental education.Results Both groups reported active use of mobile learning tools. However, students are in need of training and further guidance when searching for, evaluating and synthesising evidence-based information online. Likewise, tutors need to become familliar with e-learning tools so that they may better support their students.Conclusion The results from the study show that participants need training workshops to ensure that students are not only accessing evidence-based information, but can differentiate between evidence-based and non-evidence-based information apps. The tutors in this study also require information on how to provide their students with advice on using mobile technology. Institutions involved with clinical dentistry should acknowledge such challenges.

BackgroundIt is now widely accepted that patients can meaningfully provide feedback on the safety of their care, and recent efforts have concentrated on novel ways of gathering this feedback. Increasingly, patients are encouraged to access their electronic health record (EHR), with access associated with improved patient satisfaction and enhanced patient safety through identifying medication errors.AimWith a view to developing a novel intervention to gather safety information from patients in primary care, this study aimed to explore patients’ views on the feasibility and acceptability of inputting feedback on care experiences directly into their EHR.MethodA qualitative design and opportunity sampling strategy was used. Fifteen primary care users participated in semi-structured interviews which focused on inputting feedback into EHRs. Thematic analysis was utilised to analyse transcribed interviews.ResultsThe majority of participants were interested in viewing their EHR and felt they would benefit from providing feedback about their care experiences directly into their EHR. Three key themes were identified: monitoring EHR for improvement; security of EHR; and centralising EHR across care settings. Specific barriers and levers were recognised within each theme.ConclusionAllowing patients to have access to their EHR has the potential to improve patient experience and safety from a primary care user perspective. Nevertheless, there are barriers to consider such as, potential to increase staff workload as additional capacity may be required to interpret and act on feedback to produce service improvements.

Instant messaging (IM) is when users communicate instantly via their mobile devices, and it has become one of the most preferred choices of tools to communicate amongst health professions students. The aim of this study was to understand how dental students communicate via IM, faculty members' perspectives on using IM to communicate with students, and whether such tools are useful in the learning environment. After free-associating themes on online communication, two draft topic guides for structured interviews were designed that focussed on mobile device-related communication activities. A total of 20 students and six faculty members at the University of Birmingham School of Dentistry agreed to take part in the interviews. Students were selected from years 1-5 representing each year group. The most preferred communication tools were emails, social networking, and IM. Emails were used for more formal messages, and IM and social networking sites were used for shorter messages. WhatsApp was the most used IM app because of its popular features such as being able to check if recipients have read and received messages and group work. The students reported that changes were necessary to improve their communication with faculty members. The faculty members reported having mixed feelings toward the use of IM to communicate with students. The students wished to make such tools a permanent part of their learning environment, but only with the approval of faculty members. The faculty members were willing to accept IM as a communication tool only if it is monitored and maintained by the university and has a positive effect on learning.

Online social networking sites are a popular way to share interests, build and maintain relationships and stay more connected to the world. Tools that were not available a few years ago are now used on a daily basis. Social networking has been likened to a digital tattoo. Both Universities and Healthcare Institutions have concerns about the potential implications that students, educators and practitioners may face when using the media. The main concerns are related to patient protection by both qualified and student healthcare workers. This article outlines the guidelines put in place to avoid any mistakes made on SNS and how to maintain an e-professional aura whilst using SNS. Examples of good and bad social networking by students and practitioners are given. How the implementation of recently introduced guidelines impacts on the use of SNS in dentistry requires further research. Clinical Relevance: Social networking has become part of everyday life and yet it can create problems for dental healthcare professionals as they attempt to accommodate both personal and professional ‘aura’ in the medium.