Provision of vascular imaging results has been investigated to prompt changes towards healthy lifestyle behaviours, but effects on body composition and muscle health are unknown. This secondary analysis of a 12-week parallel-group randomised controlled trial (RCT) aims to explore body composition and muscle health effects of providing healthy lifestyle education (Ed) with and without abdominal aortic calcification (AAC) results. A total of 240 Australian community-dwelling older men and women (mean ± SD age 68 ± 5 years; 58

Introduction People living with a neurological condition face many difficulties in daily life, impacting their function and quality of life (QoL). There is currently no cure to many neurological conditions, therefore identifying interventions to improve QoL is of high importance. COVID-19 changed society in many ways and understanding the research priorities from the neurological community post pandemic is urgently needed to ensure resources are used efficiently and aligned with the needs and priorities of the community. To better understand the priority areas, it is essential for individuals with lived experience to have input into priority areas for research. Therefore, the aim of this study was to identify the top research priorities for the neurological community in Australia.Methods This priority setting study had two phases. The first phase comprised a face-to-face full day workshop held in late 2019 where participants were led through rounds of brainstorming, categorising and prioritising to reach consensus on a set of research priorities. The second phase was conducted in 2023 with an online survey distributed widely to gauge whether the initial set of research priorities had changed following the event of the global pandemic.Results On completion of the 2019 workshop there were a total of 27 priority areas with the top priority being diagnosis and early intervention. The 2023 survey results saw mental health and wellbeing moving up one position to become the highest priority.Conclusion Mental health and wellbeing moving from second in 2019 to first in 2023, shows a need for more resources and research into this area for the neurological community. Many participants suggested that mental health is at the centre of their condition and when their mental health is poor it impacts all areas of their life. The research priorities identified in this study provide direction for researchers about what is important to people living with a range of neurological conditions, allowing researchers to focus on the needs of this community.Patient or Public Contribution The data collection phase was planned in collaboration with the Consumer and Community Health Research Network, a consumer advocacy organisation. We partnered with people living with neurological conditions for the data collection for both phases and they gave feedback on the findings.

Introduction The provision of abdominal aortic calcification (AAC) imaging results can elicit cardiovascular disease (CVD)-risk reducing behaviours. However, its impact on psychosocial, mental and suboptimal health measures is less clear. Methods Secondary analyses of a previously reported 12-week, single-blind, randomised controlled trial (RCT) including 240 community-dwelling older Australian men and women. Participants were provided with AAC imaging results and CVD risk-reducing educational resources (AAC+Ed, n=121) or education alone (Control+Ed, n=119). Psychosocial distress, mental health score and suboptimal health status were estimated using validated questionnaires. Linear mixed models were used to compare changes between groups across 12 weeks. Results 240 participants (mean ± SD, age 67.8 ± 5.0 years, 57.5% females) were randomised and 227 (95%) completed the study. Approximately 57% had evidence of AAC (≥1 on a 24-point scale) at baseline. Providing AAC imaging results to older men and women did not affect psychosocial health, mental health and suboptimal health (all p>0.05) measures compared to Control+Ed. The mean net differences for change (95%CI) for depression, anxiety and stress were -0.50 (-1.42, 0.42), -0.20 (-0.81, 0.41) and -0.21 (-1.18, 0.76), respectively; the mean net difference for change (95%CI) for mental health component score was 1.69 (-1.29, 4.67) and for total suboptimal health status was -0.84 (-2.08, 0.39). Conclusions In older men and women, the provision of AAC results with education on CVD risk factors did not alter measures of psychosocial, mental, and suboptimal health status over 12 weeks compared to education alone. The study was registered at www.anzctr.org.au ACTRN12618001087246.

PURPOSE This study aimed to examine the approaches general practitioners (GPs) use to respond to the treatment burden faced by people with type 2 diabetes. METHODS We retrospectively analyzed 29 videos of GP-patient consultations in an academic general practice clinic in China. Thematic analysis and a framework matrix approach were used to identify patterns in GPs' responses to the identified issues. RESULTS The median length of the 29 video-recorded consultations was 23 minutes 54 seconds. We identified 77 segments focusing on discussions about treatment burden. In 37.7% of these segments, the GP elicited and responded to discussions about treatment burden, whereas in 23.4%, the patient initiated the discussion and the GP responded to it, leaving 39.0% in which the patient initiated the discussion but the GP did not respond. In thematic analysis, medication was the component of treatment burden most frequently identified by both patients and GPs, followed by personal resources, medical information, and administrative burden. General practitioners used 12 response approaches to address patients' treatment burden. The most frequently used included active listening and nonverbal skills, shared decision making, and confidence and self-efficacy support, which were broadly applied across various issues. In contrast, GPs typically reserved health record management, motivational interviewing, and awareness of the patient's background for specific issues. CONCLUSIONS In clinical encounters, GPs used a wide variety of approaches to respond to different aspects of the treatment burden of type 2 diabetes. Our findings emphasize the need to improve GPs' response strategies through increased responsiveness and more rapid surfacing of issues during visits.

Provision of non-invasive vascular imaging results to individuals has been shown to improve cardiovascular disease risk factor control: its impact on diet remains uncertain. In this two-arm, single-blind, parallel, 12-week randomized controlled trial, 240 participants, 57.5% females aged 60-80 y had abdominal aortic calcification and clinical assessments performed at a hospital clinic. Participants were randomized 1:1 to receive (intervention n = 121) or not (control n = 119) their calcification results. Both groups received educational resources on cardiovascular disease risk control and were unblinded to the intervention. Outcome measures were performed at baseline and 12 weeks. The primary outcomes of the study were changes in fruit and vegetable intake measures over 12 weeks assessed using plasma carotenoid concentrations (biomarkers of FV intake) and a food frequency questionnaire. Secondary outcomes included 12-week changes in other aspects of the diet, physical activity, body weight, blood pressure, heart rate, lipid profile, glucose concentrations, estimated cardiovascular disease risk score, and medication use. Between-group differences were tested using linear mixed-effects regression. There were no between-group differences in the primary outcomes at 12 weeks: plasma carotenoids (mean difference +0.03 mu g/mL [95%CI -0.06, 0.13]) and fruit and vegetable intakes (+18 g/d [-37, 72]). However, the provision of calcification results led to between-group differences in serum total (-0.22 mmol/L [-0.41, -0.04]) and non-HDL (-0.19 mmol/L [-0.35, -0.03]) cholesterol, and estimated cardiovascular disease risk score (-0.24% [-0.47, -0.02]). No between-group differences were seen for other secondary outcomes. In this work, providing vascular imaging results did not improve diet but did improve some cardiovascular disease risk factors (Australian and New Zealand Clinical Trials Registry ACTRN12618001087246). It is unclear whether providing the results of abdominal aortic calcification imaging to patients improves diet parameters. This randomized trial shows that this intervention does not lead to improvements in fruit and vegetable intake, while showing an effect on some cardiovascular disease risk factors used as secondary outcomes.

BackgroundPatients with type 2 diabetes mellitus (T2DM) frequently face a substantial treatment burden. Research on the specific treatment burden associated with T2DM is still in its early stages both in China and worldwide.ObjectiveBased on video recordings of clinical diagnostic and therapeutic scenarios, this study aims to summarize the conceptual framework of treatment burden related to T2DM among patients in China Mainland and explore proactive coping strategies of general practitioners (GPs).MethodsThe researchers conducted a retrospective qualitative analysis using video records that filmed during 201802919 from general practice training clinics of a standardized training base in Guangdong Province of China. This analysis was integrated with the existing conceptual framework of treatment burden, employing qualitative research methods such as observational record forms, field notes, coding extraction and thematic analysis.ResultsFrom 25 video records, 49 pieces of doctor-patient communication related to the treatment burden of T2DM were selected and analyzed. All six themes from the original conceptual framework were referenced to varying extents. Additionally, the researchers identified two additional themes (medical information burden and drug-induced hypoglycemia). The finding led to the creation of a modified conceptual framework for the treatment burden of T2DM, encompassing seven observable dimensions: economic burden, medication burden, medical management burden, lifestyle change burden, healthcare system burden, time/travel burden, and medical information burden. Each sub-theme's definition was expanded accordingly. The consultation process analysis indicated that trained GPs can actively address to certain treatment burdens (medication burden, medical information burden, time/travel burden, lifestyle change burden) using skills such as patient education, enhanced communication, shared decision-making and motivational interviewing."ConclusionThe study constructs a modified conceptual framework for the treatment burden of T2DM. By integrating the identification of conceptual dimensions in clinical diagnosis and treatment, it explores how Chinese GPs can use doctor-patient communication skills to proactively address specific treatment burdens of T2DM patients.

Background Understanding treatment burden is a critical element to the effective management of Type 2 Diabetes Mellitus (T2DM). The current study aims to address the knowledge gap surrounding treatment burden of T2DM from the patient’s perspective in China’s primary care settings. Methods A narrative review informed the creation of an a priori coding structure to identify aspects of T2DM treatment burden. Focus groups were conducted, employing a maximum variation sampling strategy to select participants from diverse sociodemographic backgrounds across urban, suburban, rural, and remote areas in China. Participants included adults with T2DM care in primary care settings for over a year and a Treatment Burden Questionnaire score of 25 or higher. Deductive thematic analysis, guided by the coding structure, facilitated a comprehensive exploration and further development of the conceptual framework of T2DM treatment burden. Results Four focus groups, each comprising five participants from diverse areas, were conducted. Utilising the Cumulative Complexity Model and Normalisation Process Theory as theoretical underpinnings, the thematic analysis refined the conceptual framework based on the coding structure from the narrative review. Five key themes were refined, encompassing medical information, medication, administration, healthcare system, and lifestyle. Additionally, the financial and time/travel themes merged into a new theme termed "personal resources", illustrating their overlapping within the framework. Participants in these focus groups highlighted challenges in managing medical information, an aspect often underrepresented in prior treatment burden research. The thematic analysis culminated in a finalised conceptual framework, offering a comprehensive understanding of the treatment burden experiences of people with T2DM in China’s primary care settings. This framework includes six key constructs, delineating T2DM treatment burden and associated factors, such as antecedents and consequences. Conclusions This study provides insights into the treatment burden of T2DM. A conceptual framework was finalised to deepen the understanding of the multifaceted constructs and the nature of treatment burden in people with T2DM. Furthermore, it emphasises the need to tailor T2DM treatment to individual capacities, considering their personal resource allocation and treatment utilisation.

Abstract Background Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence. Methods Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist. Results A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden. Conclusions This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.

Abstract Background Understanding treatment burden is a crucial component of effectively managing Type 2 Diabetes Mellitus (T2DM). While our previous narrative review had proposed a thematic framework for identifying treatment burden in people with T2DM, the current study aimed to fill the knowledge gap about T2DM treatment burden from the patient’s perspective in primary care settings. Methods Purposive sampling was used to recruit a spread of participants from primary care settings across various socio-economic regions in China. Focus groups were organised to explore patients’ perspectives. The discussions were audio-recorded, transcribed, and analysed with a theoretical lens of the Cumulative Complexity Model (CuCoM) to facilitate the identification and understanding of patient workload and capacity in the context. Results The study engaged four focus groups, each consisting of five participants. Building on the thematic framework from previous research, this study further refined five key themes, including medical information, medication, administration, healthcare system, and lifestyle, through subtheme refinement and categorization. A significant development was the merging of the financial and time/travel themes into a new "personal resources" theme, reflecting their overlapping nature. This refinement led to a finalised conceptual framework with six core themes, including personal resources as an overlapping theme. The framework also incorporated antecedents and consequences as themes, identifying associated factors of T2DM treatment burden. Additionally, the study highlighted an often-overlooked theme of medical information in treatment burden research and underscored systemic inadequacies within the healthcare system, highlighting the critical challenge of balancing health needs with treatment accessibility in primary care settings. Conclusions This study underscores the multifaceted nature of the T2DM treatment burden. Significantly, it contributes to the development of a conceptual framework for understanding and measuring this construct in primary care settings. The study also highlights the need to consider each patient's personal resources allocation and utilisation of treatment.

The provision of community-based space for people experiencing a mental health crisis is regarded as a favourable alternative to the emergency department. However, the only non-emergency department safe spaces in Western Australia are located within hospitals or hospital grounds. This qualitative study asked mental health consumers in Western Australia with experience of presentation at the emergency department during a mental health crisis to describe what a safe space would look and feel like. Data were collected through focus groups and thematically analysed. The findings present the voices of mental health consumers through the framework of health geography and the therapeutic landscape. These participants articulated important physical and social features of a therapeutic safe space and their symbolism as inclusive, accessible places where they would experience a sense of agency and belonging. Participants also expressed a need for trained peer support within the space to complement the skilled professional mental health team. Participants' experiences of the emergency department during mental health crises were described as contrary to their recovery needs. The research reinforces the need for an alternative to the emergency department for adults who experience mental health crises and provides consumer-led evidence to inform the design and development of a recovery-focused safe space.

OBJECTIVE:To investigate how small, local organisations were impacted by and responded to COVID-19 in their delivery of social care services to older adults (70 years and older). Lessons learnt and future implications are discussed.METHODS:Six representatives from four social care services (five females and one male) participated in individual semistructured interviews. Responses were analysed thematically.RESULTS:The key themes identified were service providers' experience, perceived needs of older adults and adapting services. Service providers positioned themselves as front-line essential workers for their older adult clients, resulting in some emotional toll and distress for the service providers. They provided information, wellness checks and at-home assistance to keep their older adult clients connected.CONCLUSIONS:Service providers feel more prepared for future restrictions but flag the potential of training and supporting older adults to use technology to stay connected, as well as the need for more readily available funding to allow services to adapt quickly during times of crisis.

Objective: This study aimed to understand the impact of COVID-19 on access to mental health and social services among older adults in Western Australia. Method: A cross-sectional study was conducted with 194 adults aged ≥70 years or ≥60 years with chronic conditions. A questionnaire co-developed by a consumer reference group was used to collect data on social networks and service access. Frequency analyses were used to assess quantitative data. Qualitative data were assessed using thematic analyses. Results: 62.7% of participants reported being not at all/slightly affected by COVID-19; 40.7% reported having three/four people to chat with. 76.3% of participants did not access mental health or social services during the 2020 COVID-19 restrictions. The remaining 23.7% mostly accessed mental health-related services, with GPs the most common source of support. 18.0% of the total sample reported choosing not to access services even though they would have liked to. Conclusions: Most older adults in this sample did not access mental health or social care services. 18.0% of all participants felt they needed services but did not access them. This suggests there were some unmet needs within the community. Strengthening social networks may help protect older adults against psychosocial declines during and post-COVID-19.

Objective Older adults are vulnerable to isolation and poor emotional wellbeing during COVID-19, however, their access to appropriate supports is unknown. The aim of this study was to explore older adults' experiences accessing social and emotional support during the COVID-19 pandemic in Australia. Method Ten older adults from Western Australia (Australia) aged 68 to 78 years participated in individual semi-structured interviews between December 2020 and January 2021. Responses were investigated using thematic analysis. Results Three key themes emerged: adaptability and self-sufficiency; informal support-seeking; and digital and online technologies. Older adults were adaptable to COVID-19 restrictions; however, some were anxious about reconnecting with their social networks once restrictions had eased. Older adults relied on their informal support networks to maintain their social and emotional wellbeing during lockdown. Digital platforms (e.g., Zoom, social media) enabled older adults to stay connected with others, yet some older people were unable or reluctant to use technology, leaving them vulnerable to social isolation. Conclusions Older adults are resilient to the challenges of COVID-19. Informal supports and digital technologies are important to maintaining social and emotional wellbeing during lockdown. Local governments and community groups may benefit from increased funding to deliver services that promote social connectedness during times of crisis.

OBJECTIVE:To investigate the Australian general public's perception of appropriate medical scenarios that warrants a call to an emergency ambulance. METHODS:An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of non-emergency scenarios (n = 8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged >18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. RESULTS:From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was 'Lego in ear canal' (11%), 'Older person bruising' (8%) and 'Flu' (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for non-emergency scenarios. CONCLUSIONS:Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts.

Objective: To investigate the Australian general public's ability to identify common medical emergencies as requiring an emergency response.Methods: An online survey asked participants to identify likely medical treatment pathways they would take for 17 hypothetical medical scenarios (eight emergency and nine non-emergency). The number and type of emergency scenarios participants correctly suggested warranted an emergency medical response was examined. Participants included Australian residents (aged > 18 years; n = 5264) who had never worked as an Australian registered medical doctor, nurse or paramedic.Results: Most emergencies were predominately correctly classified as requiring emergency responses (e.g. Severe chest pain, 95% correct). However, non-emergency medical responses were often chosen for some emergency scenarios, such as a child suffering from a scalp haematoma (67%), potential meningococcal disease (57%), a box jellyfish sting (40%), a paracetamol overdose (37%), and mild chest pain (26%). Participants identifying as Aboriginal or Torres Strait Islander suggested a non-emergency response to emergency scenarios 29% more often compared with non-indigenous participants.Conclusions: Educational interventions targeting specific medical symptoms may work to alleviate delayed emergency medical intervention. This research highlights a particular need for improving symptom iden-tification and healthcare system confidence amongst Aboriginal and Torres Strait Islander populations.(c) 2022 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Motor neurone disease causes respiratory weakness that can lead to death. While non-invasive ventilation relieves symptoms, there are complex issues to consider prior to commencement.AIM:To identify what is known and understood about the clinician communication of non-invasive ventilation by people with motor neurone disease.METHOD:The Joanna Briggs Institute approach to systematic reviews was followed for literature retrieval and selection.DATA SOURCES:Research literature published between 1990-2019 in English from the Medline, CINAHL, ProQuest Research Library and the Cochrane Library of Systematic Reviews databases were used.RESULTS:A total of two themes emerged: communication challenges doctors face when discussing non-invasive ventilation withdrawal, and the importance of well-timed, effective communication by clinicians-specifically the influence clinicians have on family decision-making.CONCLUSIONS:Guidance on communications around palliative care, non-invasive ventilation introduction and withdrawal exist, however implementation is often not straightforward. Research into the communication surrounding non-invasive ventilation from those living with motor neuron disease, their families and clinicians is required to inform guideline implementation and practice.

Background: Venous access devices are used for patients receiving long-term chemotherapy. These include centrally inserted tunnelled catheters or Hickman-type devices (Hickman), peripherally inserted central catheters (PICCs) and centrally inserted totally implantable venous access devices (PORTs). Objectives: To evaluate the clinical effectiveness, safety, cost-effectiveness and acceptability of these devices for the central delivery of chemotherapy. Design: An open, multicentre, randomised controlled trial to inform three comparisons: (1) peripherally inserted central catheters versus Hickman, (2) PORTs versus Hickman and (3) PORTs versus peripherally inserted central catheters. Pre-trial and post-trial qualitative research and economic evaluation were also conducted. Setting: This took place in 18 UK oncology centres. Participants: Adult patients (aged ≥ 18 years) receiving chemotherapy (≥ 12 weeks) for either a solid or a haematological malignancy were randomised via minimisation. Interventions: Hickman, peripherally inserted central catheters and PORTs. Primary outcome: A composite of infection (laboratory confirmed, suspected catheter related and exit site infection), mechanical failure, venous thrombosis, pulmonary embolism, inability to aspirate blood and other complications in the intention-to-treat population. Results: Overall, 1061 participants were recruited to inform three comparisons. First, for the comparison of peripherally inserted central catheters (n = 212) with Hickman (n = 212), it could not be concluded that peripherally inserted central catheters were significantly non-inferior to Hickman in terms of complication rate (odds ratio 1.15, 95% confidence interval 0.78 to 1.71). The use of peripherally inserted central catheters compared with Hickman was associated with a substantially lower cost (–£1553) and a small decrement in quality-adjusted life-years gained (–0.009). Second, for the comparison of PORTs (n = 253) with Hickman (n = 303), PORTs were found to be statistically significantly superior to Hickman in terms of complication rate (odds ratio 0.54, 95% confidence interval 0.37 to 0.77). PORTs were found to dominate Hickman with lower costs (–£45) and greater quality-adjusted life-years gained (0.004). This was alongside a lower complications rate (difference of 14%); the incremental cost per complication averted was £1.36. Third, for the comparison of PORTs (n = 147) with peripherally inserted central catheters (n = 199), PORTs were found to be statistically significantly superior to peripherally inserted central catheters in terms of complication rate (odds ratio 0.52, 95% confidence interval 0.33 to 0.83). PORTs were associated with an incremental cost of £2706 when compared with peripherally inserted central catheters and a decrement in quality-adjusted life-years gained (–0.018) PORTs are dominated by peripherally inserted central catheters: alongside a lower complications rate (difference of 15%), the incremental cost per complication averted was £104. The qualitative work showed that attitudes towards all three devices were positive, with patients viewing their central venous access device as part of their treatment and recovery. PORTs were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships. The main limitation was the lack of adequate power (54%) in the non-inferiority comparison between peripherally inserted central catheters and Hickman. Conclusions: In the delivery of long-term chemotherapy, peripherally inserted central catheters should be considered a cost-effective option when compared with Hickman. There were significant clinical benefits when comparing PORTs with Hickman and with peripherally inserted central catheters. The health economic benefits were less clear from the perspective of incremental cost per quality-adjusted life-years gained. However, dependent on the willingness to pay, PORTs may be considered to be cost-effective from the perspective of complications averted. Future work: The deliverability of a PORTs service merits further study to understand the barriers to and methods of improving the service. Trial registration: This trial is registered as ISRCTN44504648. Funding: This project was funded by the National Institute for Health Research (NHIR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 47. See the NIHR Journals Library website for further project information.

Abstract Introduction: As the understanding of health care worker lived experience during coronavirus disease 2019 (COVID-19) grows, the experiences of those utilizing emergency health care services (EHS) during the pandemic are yet to be fully appreciated. Study Objective: The objective of this research was to explore lived experience of EHS utilization in Victoria, Australia during the COVID-19 pandemic from March 2020 through March 2021. Methods: An explorative qualitative design underpinned by a phenomenological approach was applied. Data were collected through semi-structured, in-depth interviews, which were transcribed verbatim and analyzed using Colaizzi’s approach. Results: Qualitative data were collected from 67 participants aged from 32 to 78-years-of-age (average age of 52). Just over one-half of the research participants were male (54%) and three-quarters lived in metropolitan regions (75%). Four key themes emerged from data analysis: (1) Concerns regarding exposure and infection delayed EHS utilization among participants with chronic health conditions; (2) Participants with acute health conditions expressed concern regarding the impact of COVID-19 on their care, but continued to access services as required; (3) Participants caring for people with sensory and developmental disabilities identified unique communication needs during interactions with EHS during the COVID-19 pandemic; communicating with emergency health care workers wearing personal protective equipment (PPE) was identified as a key challenge, with face masks reported as especially problematic for people who are deaf or hard-of-hearing; and (4) Children and older people also experienced communication challenges associated with PPE, and the need for connection with emergency health care workers was important for positive lived experience during interactions with EHS throughout the pandemic. Conclusion: This research provides an important insight into the lived experience of EHS utilization during the COVID-19 pandemic, a perspective currently lacking in the published peer-reviewed literature.

Introduction International guidelines recommend that health care clinicians communicate with people with MND and their family members about non-invasive ventilation (NIV) and percutaneous gastrostomy tube (PEG) prior to or at the onset of respiratory symptoms. This study sought to discover the degree to which these recommendations are followed in practice. Methods Interpretive Description methodology was employed. Nineteen clinicians experienced in caring for people with MND, six relatives of recently deceased people with MND and one person with MND participated in semi-structured in-depth interviews. Clinicians’ accounts of NIV and PEG related communications were compared to family member participants’ recollections of their own discussions with clinicians. Data were analysed thematically. Results Six major themes emerged that together capture the factors that impact practitioner-patient-family communications about NIV and PEG. Some clinicians were unaware of MND guidelines particularly communicating the burdens or possible withdrawal of NIV or found them challenging to implement. Consequently, family participants reported that they and their relatives with MND found clinicians’ communication on these topics inadequate. This led to them ‘topping up’ their knowledge from less authoritative sources, predominantly the internet. Discussion Clinicians’ lack of awareness of the international guidelines and discomfort about discussing the benefits and burdens of NIV and PEGs means some people with MND and their families may be unprepared for the consequences of using and ceasing NIV.

This paper examines methodological issues related to an innovative online qualitative research project that explored ‘safe spaces’ with mental health service users. The project used photovoice and focus groups conducted via Zoom videoconferencing software. Eleven participants shared photographs, discussing their meaning and significance in relation to ‘safe spaces’. The photographs were then synthesised into an artist's impression of a safe space and transcripts of the online photovoice discussion analysed thematically and triangulated with the artist's impression. The paper provides a reflexive discussion of the research process and explores methodological and ethical implications of conducting sensitive qualitative research in online spaces.