Perceived provider barriers to collecting and documenting a complete family history in a statewide oncology consortium.

221 Background: A complete family history is essential in identifying patients who may benefit from genetic evaluation for hereditary cancer syndromes. Fewer than 40% of patients with cancer have a complete family history documented in their medical record. As part of a larger study of patient- and provider-focused interventions for increasing genetic testing, we conducted a survey of provider barriers to collecting and documenting a complete family history in a statewide, physician-led quality consortium of nearly all medical and gynecologic oncologists in Michigan. Methods: A novel survey instrument was created by adapting existing literature and clinician input. Surveys were mailed to medical and gynecologic oncologists with follow up electronic surveys sent to non-respondents. Questions addressed patient-specific barriers as well as known constraints faced by oncologists. Each barrier was rated from low to high using a 10-point Likert scale. Descriptive statistics, including mean scores and standard deviations (SD), were calculated. Results: Of 317 surveys sent, 194 (61.2%) were returned. Oncologists rated constraints on their time lower than lack of patient knowledge and understanding of their family history and its importance as a barrier. Open-ended responses indicated that the processes of collecting a family history (e.g. templates for collecting family history that omit age at diagnosis) and patients being overwhelmed at the time of consultation also interfered with collecting a complete family history. Conclusions: Oncologists perceive patient knowledge of their family history, including the ages of affected family members, and understanding of its importance as barriers to completion and documentation of a family history. Explaining the importance of the family history to patients, prompting new patients to provide their family history, and improving the process, including the timing of collection, may increase the proportion of oncology patients who have a complete family history collected and documented.[Table: see text]

IMPLEMENTATION OF TEN STEPS TOWARDS SUCCESSFUL BREASTFEEDING AT TANAH KALIKEDINDING HEALTH CENTER SURABAYA CITY, 2020

Background One of the government's efforts to increase the achievement of exclusive breastfeeding is the 10 LMKM program. Since 1991 in Indonesia, it has been introduced, but in its implementation it is not yet known by all health facilities even though several existing steps have been implemented, but the 10 LMKM policy has not been known by providers.Objectives Describe implementation and barriers to providers in program implementation, identify compliance and barriers to mothers as program recipients. Methods The research used descriptive qualitative research. The sampling technique used was purposive sampling to explore the implementation of 10 LMKM in Tanah Kalikedinding Health Center. Informants in accordance with the inclusion criteria 7 providers and 8 mothers as program recipients. Researchers interacted offline and online via video calls while adhering to health protocols. Results The implementation of 10 LMKM has been running with the internal policies of the Puskesmas referring to the Permenkes, carrying out tasks according to the SOP. Several providers have attended training and disseminated it to staff. Monitoring and evaluation is carried out through the credential team at the Puskesmas. Officers in implementing 10 LMKM to support the achievement of exclusive breastfeeding are committed to complying with the SOP. Provider barriers from external factors are the lack of health workers, especially midwives on duty, so that KIE regarding breastfeeding and others is not optimal. Mothers as program recipients when ANC is already in IEC, obediently follow the services provided and have not been fostered or referred to breastfeeding support groups. Barriers to exclusive breastfeeding in program implementation are influenced by external factors of working mothers. Conclusion The implementation of the 10 LMKM program at the Tanah Kalikedinding heath center has not been maximized.

IMPLEMENTATION OF TEN STEPS TOWARDS SUCCESSFUL BREASTFEEDING AT TANAH KALIKEDINDING HEALTH CENTER SURABAYA CITY, 2020

Background One of the government's efforts to increase the achievement of exclusive breastfeeding is the 10 LMKM program. Since 1991 in Indonesia, it has been introduced, but in its implementation it is not yet known by all health facilities even though several existing steps have been implemented, but the 10 LMKM policy has not been known by providers.Objectives Describe implementation and barriers to providers in program implementation, identify compliance and barriers to mothers as program recipients. Methods The research used descriptive qualitative research. The sampling technique used was purposive sampling to explore the implementation of 10 LMKM in Tanah Kalikedinding Health Center. Informants in accordance with the inclusion criteria 7 providers and 8 mothers as program recipients. Researchers interacted offline and online via video calls while adhering to health protocols. Results The implementation of 10 LMKM has been running with the internal policies of the Puskesmas referring to the Permenkes, carrying out tasks according to the SOP. Several providers have attended training and disseminated it to staff. Monitoring and evaluation is carried out through the credential team at the Puskesmas. Officers in implementing 10 LMKM to support the achievement of exclusive breastfeeding are committed to complying with the SOP. Provider barriers from external factors are the lack of health workers, especially midwives on duty, so that KIE regarding breastfeeding and others is not optimal. Mothers as program recipients when ANC is already in IEC, obediently follow the services provided and have not been fostered or referred to breastfeeding support groups. Barriers to exclusive breastfeeding in program implementation are influenced by external factors of working mothers. Conclusion The implementation of the 10 LMKM program at the Tanah Kalikedinding heath center has not been maximized.

Organizational and individual barriers and facilitators to the integration of pediatric palliative care for children: A grounded theory study

Background: Pediatric palliative care has established benefits for children with cancer and their families. Overcoming organizational and healthcare provider barriers have been demonstrated as central for the provision of palliative care in pediatric oncology. A deeper understanding is needed of the influence of these barriers and the interactions between them, specifically in primary palliative care in hospital settings. Aim: To identify the organizational and healthcare provider barriers to the provision of primary pediatric palliative care. Design: This study utilized the grounded theory method. Semi-structured interviews were conducted and analyzed line by line, using NVivo software. Setting/participants: Forty-six pediatric oncologists, nurses, psychosocial team members, and other healthcare providers from six academic hospital centers participated in the research. Results: Organizational and healthcare provider factors were identified, each of which acted as both a barrier and facilitator to the provision of pediatric palliative care. Organizational barriers included lack of resources and management. Facilitators included external resources, resource management, and a palliative care center within the hospital. Individual barriers included attitudes toward palliative care among pediatric oncologists, pediatric oncologists’ personalities, and the emotional burden of providing palliative care. Facilitators include dedication and commitment, initiative, and sense of meaning. Provider facilitators for palliative care had a buffering effect on organizational barriers. Conclusion: Organizational and healthcare provider factors influence the quality and quantity of palliative care given to children and their families. This finding has implications on interventions structured to promote primary palliative care for children, especially in healthcare systems and situations where resources are limited.

Identifying Nurses’ Perceived Barriers to Mobilizing Patients on a Medical-Surgical Unit: A Quality Improvement Project

Researchers have found that low and moderate levels of mobility are independently associated with greater functional decline in activities of daily living (ADLs) at discharge (Zisberg et al., 2011) and that bedrest promotes declines in muscle mass and muscle strength (Coker et al., 2014; Dirks et al., 2016). The negative effects of low mobility and immobility are recognized by nurses, yet most acute care nurses do not prioritize the mobilization of their patients. Interventions to increase mobilization of hospitalized patients may be more effective if they are barrier targeted. The purpose of this quality improvement project was to identify nurses’ perceived barriers to mobilizing patients on a medical-surgical unit in a community hospital. The project used a 26-item 5-point Likert style survey adapted from the Overall Provider Barriers survey; a validated self-administered survey developed by Hoyer et al. (2015). The survey identified nurses’ perceived barriers in three domains: knowledge, attitudes, and behaviors. A convenience sample of 28 nurses participated in the survey. Results demonstrated that three of the four most reported perceived barriers were in the behaviors domain, which assessed external factors that could influence the respondent’s decision to mobilize or to not mobilize a patient. The highest barriers in the behaviors domain were inadequate staffing, lack of time, and patient resistance to being mobilized. The third highest overall barrier was the perception that increasing patient mobilization would be more work for nurses. This item was in the attitudes domain, which assessed the respondent’s perception of patient safety, needs, and outcomes of mobilization and perception of available time, workload, and ability to mobilize patients. Results were consistent with previous studies that explored barriers to mobilization. Practical implications of the findings are discussed.

The Relationship Between Provider Gender Preferences and Perceptions of Providers Among Veterans Who Experienced Military Sexual Trauma

Previous research has demonstrated that most veterans who have experienced military sexual trauma (MST) have provider gender preferences. Although provider gender mismatch, defined as not receiving a provider of the gender of one’s preference, may deter veterans from disclosing MST or seeking MST-related care, there is little research that has examined this issue. The current study aimed to explore how provider gender mismatch is related to veterans’ comfort with providers, perception of their providers’ competency, and their endorsement of perceived provider barriers when communicating about MST. The current study was conducted as part of a larger national survey of veterans’ barriers to accessing MST-related care. Participants in the study were identified using Veterans Health Administration (VHA) administrative data. Criteria for inclusion in the overall study were being enrolled in VHA health care, having screened positive for MST, and having received at least one VHA outpatient service. A subset of eligible veterans who had endorsed MST, reported a provider gender preference, and endorsed discussing MST with a VHA provider ( N = 1,591) were included in the current study. Results demonstrated that provider gender preference mismatch was associated with greater endorsement of perceived provider barriers, less comfort with providers, and lower perceived provider competency in women; and greater perceived provider barriers and less comfort with providers among men. The study demonstrates that provider gender preferences may affect care for veterans who have experienced MST, and that the impact may differ for men and women. These findings may be used to improve patient-centered care and inform future research regarding veterans’ provider gender preferences.