Transition from children’s social care is a complex and often challenging process, and coordination between different agencies, such as health, education, and social care, is important to ensure effective communication, engagement, and continuity of care. This review focuses on young people’s experiences with multi-agency approaches to support transition from children’s social care to adults’ social care or support, their perceptions of success of such approaches, and barriers and facilitators of implementing multi-agency approaches to transition and to young people engaging with them. This review included 22 UK studies published between 2014 and 2025. Seven of the studies focused on care leavers, six on young people with learning disabilities (LD) or special educational needs or disabilities (SEND), five on young people in the justice system, and four on other groups of young people. Many of the multi-agency initiatives primarily focused on housing support. For young people in the justice system, the initiatives mainly focused on resettlement in community. There were also studies about broader planning for support needs when the young person transitioned to adulthood. The experiences and perceived success of multi-agency working: Care leavers’ experiences of transitions varied, with some young people experiencing anxiety and distress. Perceptions of the benefits of initiatives often related to the quality of their relationship with their transition worker. Some young people said their confidence, general skills, social relationships, and mental health improved during their involvement in multi-agency initiatives. Little evidence was identified about experiences of young people with LD/SEND. For young people in the justice system, mixed experiences were described. Little information was identified about success of multi-agency work as perceived by young people. Some positive experiences with multi-agency working were also described. Barriers and facilitators of implementing multi-agency work: Barriers included insufficient resources, structural issues and policy and strategy limitations. Shared practices, priorities, and vision as well as information sharing between agencies were important. A significant practitioner-related factor was staff expertise. Barriers and facilitators of young people engaging with multi-agency work: Awareness of the services and flexibility in how young people could engage with them were important factors. More support with engagement for young people could act as a facilitator. Personal factors that might act as barriers to engagement for young people were identified. Good relationships with staff and positive staff attitudes were important facilitators. The review identified evidence gaps and a need for further robust research.

This review aimed to identify and review any brain tumour-specific holistic needs assessment (HNA) and the clinical implementation of any HNAs in an adult cancer population. A systematic review and narrative synthesis. Five electronic databases were searched from 2008 to 2023 and updated in January 2025. Reference lists of systematic reviews were screened for relevant studies. Two independent reviewers performed study selection, critical appraisal, and data extraction. Four HNA tools implemented in clinical practice, across 9 studies, were included. One study was adapted for brain tumour patients. Evidence of widespread implementation in clinical practice was limited and varied evidence, relating to the timing, location and mode of delivering. Patients were more likely to report on physical rather than psychosocial needs, with limited evidence of patient and staff satisfaction with the use of HNA. There is limited and varied evidence of HNAs being successfully implemented in brain tumour and the wider cancer healthcare settings. Tailored interventions for the needs of people with brain tumour have the potential to address the complexities this population faces. However, clear evidence-based guidance to develop relevant HNAs for successful implementation in clinical settings is needed.

Abstract Background Adults (age 18–64 years) are recommended 150–300 min of moderate-to-vigorous or 75–150 min of vigorous-intensity physical activity per week. Irrespective, the number of women not meeting recommended physical activity is 5% higher than men globally. Women, girls and people who menstruate face multiple barriers to physical activity participation, including gender bias, low perceived exercise competence, and insufficient support from peers and/or family. Moreover, menstruation is often reported as a barrier. Numerous interventions have been proposed to increase women’s and girls’ physical activity participation, while little is known about interventions for people who menstruate. Therefore, the aim of this rapid overview of reviews was to summarise systematic reviews investigating the effectiveness of interventions that support women, girls, and people who menstruate to participate in physical activity. Additionally, this review examined whether any of these interventions incorporated managing physical activity participation throughout the menstrual cycle. Methods Bibliographic databases (MEDLINE, Emcare, and AMED on OVID platform; CINAHL and SPORTDiscus on EBSCO; Epistemonikos, and Cochrane Database) and grey literature were searched in March 2024. Title/abstract screening was conducted by one reviewer and 20% of records checked by a second. Full-text screening was performed by two reviewers. Data extraction and critical appraisal (using JBI systematic review checklist) were conducted by one reviewer with another checking accuracy. Findings were summarised narratively. Results Fifteen systematic reviews across 16 reports (published between 2008 and 2024) met the inclusion criteria. The population included young and adolescent girls (n = 9), adult women (n = 3), mothers and daughters (n = 2), and mixed population (n = 1). A wide range of interventions were identified which were educational, environmental or multicomponent. None of the included systematic reviews described interventions focusing on managing physical activity participation throughout the menstrual cycle. Most reviews found mixed effectiveness in increasing physical activity participation, leading to inconclusive results. Conclusion While multicomponent interventions may lead to better physical activity outcomes, it is unclear what combined elements are the most effective. There is a need for high quality research to identify interventions that could help girls, women, and people who menstruate to be physically active, and consider barriers related to the menstrual cycle. Review registration https://doi.org/10.17605/OSF.IO/XTYCW

Evaluating the methodological quality of primary studies is a crucial aspect of evidence syntheses, such as rapid reviews. Rapid reviews often include both randomised controlled trials (RCTs) and non-randomised studies (NRSIs) requiring multiple design-specific quality assessment tools. This can complicate workflows and reduce efficiency. Unified tools, designed to assess methodological quality across diverse study designs, may offer a more consistent and streamlined approach. This scoping review aimed to comprehensively identify and describe unified tools for assessing methodological quality across both RCTs and NRSIs. The review followed JBI scoping review methodology and was reported in line with PRISMA-ScR guidance. Searches were conducted in MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCO) from 1998 to 2024, alongside grey literature searches, citation tracking, targeted website searches, and consultation with experts in evidence synthesis. Study selection was performed by two independent reviewers. A tool was defined as any structured instrument developed to support users in assessing methodological quality. A total of 55 publications were included, identifying 29 unique unified tools. These were categorised by structure: scales (n = 14), checklists with an additional summary judgement (n = 7), simple checklists (n = 5), domain-based tools (n = 2), and other tools (n = 1). All tools were designed to assess both RCTs and NRSIs, with many also applicable to additional study designs, including descriptive studies (n = 15), case reports or series (n = 9), qualitative research (n = 7), and systematic reviews (n = 3). Unified tools were developed using a mixture of approaches including literature reviewing (n = 25), expert consensus (n = 20), and stakeholder consultations (n = 17) and pilot testing (n = 17). Evaluation of psychometric properties was conducted to varying levels across different domains of validity and reliability. This review identified a diverse set of unified tools for assessing methodological quality across both RCTs and NRSIs. However, variation in tool structure, the availability of accompanying guidance, and the limited evaluation of psychometric properties, particularly inter-rater reliability and criterion validity, indicate potential issues for adoption in rapid reviews. Unified tools need further refinement and validation to be embedded in the rapid review process. https://osf.io/nyteu/

Introduction:Adult social care in the UK faces increasing demand and persistent inequalities in terms of access and care quality, yet national-level understanding remains limited. The CARE Lab study aims to address these gaps using newly available individual-level routine administrative data for the whole of Wales from the Adults Receiving Care and Support (ARCS) census. This study will explore patterns of care provision, transitions from children's to adult services, and socio-demographic disparities, using linked data to inform service planning and policy. Methods:and analysis This quantitatively-led mixed-methods study comprises five research questions. Quantitative analysis will use ARCS census data, both standalone and linked to health, education, and social care datasets within the Secure Anonymised Information Linkage (SAIL) Databank. Qualitative interviews with people receiving care and support, carers, and professionals will contextualise findings. Key research questions address care patterns, demographic comparisons, regional variation, transitions from child to adult care, and the feasibility of evaluating care models using linked data. Statistical analyses will include descriptive and inferential statistics, propensity score matching, and there will be thematic analysis of qualitative data. Ethics:Ethical approval has been obtained from Cardiff University. Data access approvals will be sought from Welsh Government, SAIL, and the Office for National Statistics. Dissemination will occur through peer-reviewed publications, policy briefings, accessible multimedia outputs, and stakeholder engagement via an action group. The study will also produce a research-ready data asset and recommendations for future data infrastructure development across the UK.

Introduction: Bereavement affects individuals in diverse ways, and the support they require can vary significantly. For grief to be effectively recognised and addressed in both clinical and research settings, appropriate and validated assessment tools are essential. However, there is a notable gap in child-specific tools, particularly those that use non-verbal approaches to support young children and individuals with Special Educational Needs (SEN), who may have limited verbal communication.Aims: This scoping review aims to explore and map existing evidence on grief and mental health assessment tools that incorporate non-verbal methods. The focus is on tools used with children aged 11 and under, and with older children or adults who have additional learning or communication needs, in therapeutic and research contexts.Methods: We conducted a scoping review using Arksey and O'Malley's five-stage framework. Searches were carried out across five databases - CINAHL, Medline, PsycINFO, Cochrane Library and Scopus - from their inception to 7 December 2023. Data from eligible studies were analysed using descriptive statistics and content analysis.Findings: From 1498 screened papers, 22 articles were included. Most described mental health tools rather than grief-specific assessments. Five key themes emerged: tool development processes; language and item selection; use of visual imagery; response format design and psychometric properties, including feasibility and utility. These features illustrate how non-verbal methods can support communication and engagement in assessment.Conclusion: This review highlights current approaches to assessing grief and mental health in children and individuals with SEN using combinations of verbal and non-verbal methods. It provides a foundation for future development of accessible, structured grief assessment tools tailored to these populations and underscores the urgent need for such resources in practice.

People with learning disabilities (LD) have a higher prevalence of health problems than in the general population across many health conditions. At the same time, they often face difficulties in accessing healthcare, experience many health inequalities, and are more likely to die of preventable causes than people in the general population. Learning Disability Liaison (LDL) services were established in the United Kingdom (UK) and the Republic of Ireland (ROI) to support patients with LD in accessing care. The services aim is to improve the quality of care delivery and ensure an equitable and safe service. This review summarises existing evidence from the UK and the ROI regarding the effectiveness of LDL services in improving health-related outcomes for people with LD in secondary care. The review also reports the barriers to and facilitators of implementing LDL services reported in published literature. The included literature was published between 2002 and 2025. 44 academic studies, organisational reports, and other types of literature were identified. Of these, 21 were academic studies from England, Scotland, Wales, and the ROI, and 23 were organisational reports or other types of literature. No studies assessed the effectiveness of LDL services in improving health outcomes for people with LD, but many focused on assessing the impact of LDL services on the care provided. Some evidence suggested that having LDL nurses was a facilitator of identifying patients with LD. Literature reported that LDL nurses facilitated provision of reasonable adjustments and potentially improved patients experiences with hospital care and their ability to access treatments, however, there was some literature that reported mixed or negative experiences. LDL nurses were sometimes described as playing an important role in preparing and sharing accessible information with patients and carers, facilitating communication between patients and carers and hospital staff, and preparing hospital passports for patients with LD. However, some literature reported that other hospital staff did not always consult hospital passports, making them ineffective. There was some evidence that employing an LDL nurse might be associated with reduced length of stay and readmission rates. The review identified barriers to implementation of LDL services, and also barriers to accessing these services. This review provides a broad overview of the functioning of LDL services, with wide-ranging types of outcomes and examples of practice. This can help in designing LDL services and allocating resources. The evidence on the barriers of implementing and accessing LDL services provides a useful resource for service providers seeking to implement or improve LDL services. There is a need for more independent research evaluating the effectiveness of LDL services, particularly in relation to health outcomes.

Future care planning (FCP) is increasingly discussed within supportive and palliative care policy contexts in the UK and internationally. This article incorporates a scoping review of the literature to provide a summary overview. FCP is discussed as a policy element improving end-of-life care by encompassing advance care planning and furthermore including individuals with diminished decision-making capacity through a best-interests approach. The evidence base further indicates that FCP is being increasingly applied in palliative care settings worldwide and has been adopted as part of several national strategies, including in Wales and in Scotland. A clear and consistent definition of FCP will help support health and social care professionals working in frailty and palliative care. Our review identified definitions of FCP in the existing literature and described what a future care plan is, including what end-of-life care should look like and incorporate.

The COVID-19 pandemic presented policymakers with time-sensitive decision problems and a rapidly increasing volume of research, not all of which was robust, or relevant to local contexts. A bespoke evidence review process supporting stakeholder engagement was developed as part of the Wales COVID-19 Evidence Centre (WCEC), which could flexibly react to the needs of decision-makers, to address urgent requests within days or months as required. To describe and appraise the WCEC review process and methods and identify key learning points. Three types of rapid review products were used, which could accommodate the breadth of decision problems and topics covered. Stakeholder (including public) engagement was integrated from the onset and supported throughout. The methods used were tailored depending on the needs of the decision-maker, type of research question, timeframe, and volume and type of evidence. We appraised the overall process and compared the methods used with the most recent and relevant best practice guidance. The remote collaboration between research teams, establishing a clear pathway to impact upfront, and the strong stakeholder involvement embedded in the review process were considered particular strengths. Several key learning points were identified, which focused on: enhancing stakeholders’ abilities to identify focused policy-relevant research questions; the collection and storage of review protocols at a central location; tightening quality assurance process regarding study selection, data extraction and quality assessment; adequate reporting of methodological shortcuts and understanding by stakeholders; piloting of an algorithm for assigning study design descriptors, and a single quality assessment tool covering multiple study designs; and incorporate, where appropriate an assessment of the confidence in the overall body of evidence using GRADE or similar framework. The review process enabled a high volume of questions that were directly relevant to policy and clinical decision making to be addressed in a timely manner using a transparent and tailored approach.

Objectives This review aimed to collate evidence on the key information and communication needs of patients with advanced incurable cancer and their caregivers. It also sought to identify barriers and facilitators to communicating, understanding and receiving information, with the view of influencing improvements to future practice. Methods This study used a rapid review methodology. Databases were searched on the Ovid platform to identify relevant qualitative data. Methodological quality was assessed, and data extraction was completed. A thematic synthesis approach was used for data analysis. Results Findings from 42 articles highlighted that key information should be communicated in accordance with individual needs, including tailoring when and how information is provided. It also highlighted the need for healthcare professionals to provide adequate time, openness, and sensitivity to facilitate understanding of prognosis, treatment and care options. Barriers to receiving, communicating and understanding information relating to healthcare professionals and healthcare systems focus on inadequate time in consultations and a lack of specified point of contact. Patient level barriers included difficulties engaging with and processing challenging information, and inadequate health and death literacy. Facilitators included incremental information provision and early access to palliative care specialists. Conclusions Key communication and information needs identified in the review’s synthesised findings should be considered when developing communication strategies alongside the barriers and facilitators. Practice implications HCPs should provide patients and caregivers with bespoke support to improve their health and death literacy, and a direct point of contact. Health service training could focus on personalised and empathetic information delivery.

It is estimated that one in four people will experience poor mental health throughout their lifetimes. However, ethnic minority groups, refugees and asylum seekers experience more barriers accessing mental health services and have poorer mental health outcomes than those from non-ethnic minority groups. Evidence suggests that interventions that improve access and engagement with mental health services may help reduce disparities affecting ethnic minority groups, refugees and asylum seekers. Thus, the aim of this rapid evidence summary was to explore the literature on what works to support better access to mental health services for ethnic minority groups, refugees and asylum seekers to reduce inequalities. The review included interventions that were developed or assessed to improve equity in access, engagement, utilisation, or provision of mental health services.Research Implications and Evidence Gaps There is limited review evidence regarding the effectiveness of interventions to improve access to mental healthcare across ethnic minority groups. Review evidence regarding interventions to support refugees and asylum seekers access to primary healthcare or specialised clinics (for example pregnancy and postpartum) is available, but the findings related to mental health care cannot be extracted.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThe Centre for Health Economics and Medicines Evaluation, the Bangor Institute for Medical and Health Research, and the Swansea Centre for Health Economics were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors* BAME : Black, Asian and minority ethnic NHS : National Health Service OECD : Organisation for Economic Co-operation and Development ONS : Office for National Statistics PTSD : Post-traumatic stress disorder RCT : Randomised Control Trial VCSE : Voluntary Community and Social Enterprise

Private law childrens proceedings typically involve court disputes between parents who have separated and disagree about child arrangements, and are asking the court to make orders that determine where a child should live and with whom they should spend time. Children involved in private law, who potentially represent a vulnerable group, commonly receive less attention in policy than those in public law cases. The aim of this review was to shine a light on the wellbeing and other important characteristics or outcomes of children who are currently, or have been, involved in family law proceedings due to parental separation, to identify the support needs of these children who are often overlooked in policy. This rapid review is intended for policymakers who are responsible for policy concerning children and families as well as for family law professionals and families in private law childrens proceedings. The literature searches were conducted between June and August 2024. The included literature was published between 2001 and 2022. 22 studies reported in 25 documents were identified (8 published in academic journals and 17 in reports produced by organisations). Originated in England and Wales (n=13), Australia (n=7), Canada (n=1), New Zealand (n=1). Most studies aimed to describe the characteristics of children who are or have been involved in private family law proceedings, whilst only one compared the outcomes of such children to those in the general population. Almost all of the studies addressed mental health and emotional wellbeing. Written accounts of children, parents, and professionals described children as having anxiety, depression, anger, post-traumatic stress disorder symptoms, and eating disorders, and experiencing self-harm and suicide attempts. In Wales, children with a history of involvement in private law proceedings had higher incidence of depression and anxiety than children in the general population. From the evidence, it was unclear whether the poor mental health was associated with parental separation, the court proceedings, court orders, or some other factors, but some participants attributed difficulties to unwanted court orders. Other key areas of evidence included engagement with mental health services, behaviour, development, social relationships, learning and education, and physical health. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Cardiff Evidence Synthesis Collaborative were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Abstract Background The COVID-19 pandemic presented policymakers with time-sensitive decision problems and a rapidly increasing volume of research, not all of which was robust, or relevant to local contexts. A bespoke evidence review process supporting stakeholder engagement was developed as part of the Wales COVID-19 Evidence Centre (WCEC), which could flexibly react to the needs of decision-makers, to address urgent requests within days or months as required.Aims To describe and appraise the WCEC review process and methods and identify key learning points.Methods Three types of rapid review products were used, which could accommodate the breadth of decision problems and topics covered. Stakeholder (including public) engagement was integrated from the onset and supported throughout. The methods used were tailored depending on the needs of the decision-maker, type of research question, timeframe, and volume and type of evidence. We appraised the overall process and compared the methods used with the most recent and relevant best practice guidance.Results The remote collaboration between research teams, establishing a clear pathway to impact upfront, and the strong stakeholder involvement embedded in the review process were considered particular strengths. Several key learning points were identified, which focused on: enhancing stakeholders’ abilities to identify focused policy-relevant research questions; the collection and storage of review protocols at a central location; tightening quality assurance process regarding study selection, data extraction and quality assessment; adequate reporting of methodological shortcuts and understanding by stakeholders; piloting of an algorithm for assigning study design descriptors, and a single quality assessment tool covering multiple study designs; and incorporate, where appropriate an assessment of the confidence in the overall body of evidence using GRADE or similar framework.Conclusions The review process enabled a high volume of questions that were directly relevant to policy and clinical decision making to be addressed in a timely manner using a transparent and tailored approach.

It is estimated that one in four people will experience poor mental health throughout their lifetime. However, ethnic minority groups, refugees and asylum seekers experience more barriers accessing mental health services and have poorer mental health outcomes than those from non-ethnic minority groups. Evidence suggests that interventions that improve access and engagement with mental health services may help reduce disparities affecting ethnic minority groups. This review aims to assess the effectiveness of interventions that enhance equitable or overall access to mental health services by ethnic minority groups. The review included evidence available up until 19th December 2023. Psycho-educational interventions that focused on providing culturally appropriate information, showed mixed results for help seeking behaviour, improvements in depressions stigma. Multi-component interventions within healthcare settings had mixed results. Some studies showed positive outcomes; such as increased help seeking intentions and improved attendance rates, while others did not show significant differences in outcomes. Interventions that included integrating specialist mental health services within primary care resulted in variable outcomes. The findings of interventions incorporating language support into mental health services were also variable. The effectiveness of interventions to enhance the cultural competency of mental health services varied across studies. Research Implications and Evidence Gaps Future research should prioritise rigorous study designs, including randomised controlled trials and longitudinal studies. More research is required to compare outcomes between ethnic minority participants and White participants. Economic considerations Ethnic minority individuals are disproportionately affected by economic determinants of poor mental health including increased likelihood of low income. Future research should investigate the economic benefit from an NHS and societal perspective of improving access to mental health services for ethnic minority individuals. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The Wales Centre for Evidence Based Care, the Specialist Unit for Review Evidence for Health Economics, and the Centre for Health Economics and Medicines Evaluation were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * aOR : Adjusted Odds Ratio aHR : Adjusted Hazard Ratio aIRR : Adjusted Incident Rate Ratio CAMHS : Child and Adolescent Mental Health Services CG : Control group CI : Confidence interval GP : General practitioner IAPT : Improving Access to Psychological Therapy IG : Intervention group IRR : Incident Rate Ratio OR : Odds Ratio QCC : Quality Criteria Checklist RCT : Randomised Controlled Trial SD : Standard Deviation SE : Standard Error

Advanced cirrhosis confers a significant symptom burden and has a 50% 2-year mortality rate in those with decompensated disease. There is increasing demand for supportive and palliative care (SAPC) for these patients, yet no consensus on the best model of delivery. It is necessary to identify the needs of such patients and their carers, and evaluate whether they are being met.A literature search was conducted using key words pertaining to adult patients with liver cirrhosis and their SAPC needs. Study quality was assessed and findings grouped by theme. 51 full texts were selected for inclusion, 8 qualitative studies, 33 quantitative studies, 7 systematic reviews, 2 mixed methods studies and 1 Delphi methods. Key findings were grouped into three main themes: SAPC needs, access to SAPC and models of care.Patients with cirrhosis have significant psychological and physical symptom burden with many unmet needs. These data failed to identify the best service model of care. The impact of specialist palliative care (SPC) referral was limited by small numbers and late referrals. With the majority of studies conducted in the USA, it is unclear how well these findings translate to other healthcare systems. Comparison between hepatology led services and SPC was limited by inconsistent outcome measures and prevented pooling of data sets. These data also had limited evaluation of patient-reported outcome measures. We propose the development of a core outcome set to ensure consistent and meaningful evaluation of the SAPC needs of patients with advanced non-malignant liver cirrhosis.

Introduction In the United Kingdom, over 12,000 adults a year are diagnosed with a brain tumour, accounting for 3% of all new cancer cases. The needs of patients with brain tumours are unique and complex. At present, patients with brain tumours have inconsistent assessment of their supportive care needs across care settings in Wales and the wider UK. Studies conducted in any adult cancer population which assess clinical implementation of a Holistic Needs Assessment (HNA) may provide evidence applicable to the brain tumour population. Aims To identify any HNAs of relevance to the care of those with brain tumours, we sought to examine clinical implementation of HNAs in any adult cancer population. Method Five databases were searched using text words and medical subject headings from 2008 to March 2023. Reference lists of systematic reviews were checked for relevant studies. Two independent reviewers performed study selection, critical appraisal, and data extraction. Results Although numerous HNAs exist, there is very limited research evidence of widespread implementation in clinical practice. Of the 660 studies identified, 113 abstracts were screened, and 5 studies were included in this review, yielding mixed results. Four studies were based in the UK and one in Canada. Only one study reported a brain-tumour-specific HNA tool for use in the neuro-oncology outpatient clinic. Studies consisted of heterogeneous study designs and small sample sizes. Conclusion HNAs are important for good patient experience as the assessment is used to address unmet patients' needs and identify areas where extra support or signposting to other services is required. The studies reported mixed results on implementation of HNAs in clinical practice identifying important implications for patients with brain tumours. Impact The findings show the necessity for the development of a brain tumour specific HNA to address the specific needs of those with brain tumours at an individual patient and caregiver level.

Insufficient physical activity is a leading risk factor for non-communicable diseases and has a negative effect on mental health and quality of life. Women, girls and people who menstruate living in Wales are less likely to engage in regular physical activity than boys and men. The aim of this rapid evidence summary is to identify research focusing on physical activity participation (including exercise and sport) of women, girls and people who menstruate in relation to the menstrual cycle, to inform the Welsh Government Period Proud Action Plan. Results 42 reports were identified, including overviews of reviews, systematic reviews, a scoping review, organisational reports, and primary studies. The secondary research evidence was published between 2008 and 2024 with the most recent searches being conducted in September 2023. The primary studies were published between 2020 and 2022. The organisational reports were published between 2018 and 2024. Research Implications and Evidence Gaps There is a need for interventions that could support physical activity participation (including exercise or sport) of women, girls and people who menstruate in relation to the menstrual cycle. These interventions need to consider and address barriers that women, girls and people who menstruate face in relation to their menstrual cycle, and robust evaluations are required to determine effectiveness. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The Cardiff Evidence Synthesis Collaborative were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Introduction Patients with advanced non-curative cancer are typically offered active palliative treatments (Chemotherapy, radiotherapy and immunotherapy). However, evidence suggests that when active treatment is used near the end of life it can result in worse quality of life, particularly those facing 30-day mortality. Patients’ preferences should therefore be carefully integrated into these treatment decisions. Aims We aimed to identify and explain contextual factors and intervention mechanisms that influence patients experiences in making decisions about palliative treatments and supportive care, when supported with patient aids and shared decision-making approaches. Methods A realist review method (co-produced with public and clinical stakeholders) was used to search, appraise, synthesise and analyse the current research evidence. A theoretical model was produced to explain connections between contextual factors, intervention mechanisms and patient experience outcomes. Results We included 41 papers in the review and produced a theoretical model which explains how patient (and family) experiences, clinician support, access to palliative care and communication can influence patients’ engagement and satisfaction with decisions. It outlines how mechanisms such as enabling preparation for decision-making, providing accessible information, increased palliative care involvement, and supporting opportunities for patients to reflect on preferences and prior experiences of treatment decision-making. Conclusions In order to improve patient’s experiences of making difficult decisions about treatments for advanced cancer and supportive care they need time to engage with key information, revisit and re-evaluate information and decision-making before and during consultations. Multi-component, multi-format interventions that include additional input from palliative care specialists may prove most effective. Impact These key contexts and intervention mechanisms identified can be incorporated in the design of a complex intervention aimed at improving treatment decision-making for patients with advanced non-curative cancer.

Special procedures, such as tattooing (including semi-permanent make-up), body piercing, acupuncture and electrolysis involve piercing the skin and carry a potential risk of infection and other complications. This review provides an up-to-date evidence base on the main physical health risks associated with these special procedures.Searches were conducted for research published between 2015 and 2023. Where possible, existing reviews were used. For tattooing, one systematic review including 55 studies was identified. For semi-permanent make-up, 37 cases presented in 31 case reports were identified. For body piercing, four systematic reviews were identified, which covered 174 studies. For acupuncture, one evidence map of 535 systematic reviews without age limits and one overview of 24 systematic reviews focused on children were included. For electrolysis, one case report was identified.Complications and adverse events resulting from special procedures include fungal infections, bacterial infections, viral infections, blood-borne infections, allergic reactions, malignant growths, benign growths, sarcoidosis-related reactions, and a range of other skin and eye-related adverse reactions and dental issues.Research Implications and Evidence Gaps Most of the primary evidence for the physical health risks associated with the special procedures came from case reports and case series, which do not allow causal inferences or provide information on the prevalence of adverse events. Future primary research should employ more robust designs to gather evidence about the causal links between special procedures and adverse physical health events as well as about the prevalence of such events in people receiving special procedures. More evidence is needed to identify physical health risks associated with electrolysis.Policy and Practice Implications The evidence contained in this review will be used to inform the training of local authority enforcement officers and special procedures practitioners and to educate members of the public who seek to use these services. Due to the nature of the special procedures which involves piercing the skin and poses the risk of introducing infections to the body, high standards of hygiene may reduce the rate of infection.Funding statement The Wales Centre for Evidence Based Care, and the Specialist Unit for Review Evidence, were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThe Wales Centre for Evidence Based Care, and the Specialist Unit for Review Evidence, were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present study are available upon reasonable request to the authors* CI : Confidence Interval ER : Event Rate GRADE : Grading of Recommendations, Assessment, Development and Evaluation HIV : Human Immunodeficiency Virus OR : Odds Ratio RR : Relative Risk SR : Systematic Review UK : United Kingdom USA : United States of America