Ischaemic heart disease (IHD) is a global health issue, with people of Indian origin facing earlier onset and more severe cases, leading to higher mortality at younger ages compared to Western countries. Indian migrants maintain similar risks post-migration. Managing modifiable risk factors and improving risk knowledge and health-seeking behaviours are essential, but research on IHD risk perceptions among Indian migrants is limited.

This study explores how first-generation Indian migrants perceive their IHD risk and the factors influencing these perceptions.

As a component of a mixed- method study, a qualitative descriptive study design was employed to examine study participants perception of their IHD risk and the influencing factors. Semi-structured interviews were conducted with Indian migrants residing in metropolitan Melbourne, Victoria using multiple Indian languages and English. Data were analysed in the original language, with findings reported in English. NVivo software was used for data management and analysis. A qualitative content analysis was conducted using a hybrid coding approach where the main categories were developed deductively and subcategories were developed inductively from the data.

Twenty interviews were conducted with participants aged 32 to 70, 55% of whom were female, with an average stay in Australia of 11.2 years. The main themes included: perceptions shaped by personal experiences, especially family history, with most underestimating their risk; migration, cultural norms, and time constraints hindering behaviour change; family support, religious beliefs, and longevity aspirations motivating healthier behaviours; and limited primary healthcare engagement and culturally appropriate health resources. These results are discussed within the context of Capability, Opportunity and Motivation model of behaviour change (COM-B).

The study highlights key factors influencing IHD risk perceptions among Indian migrants. By understanding these specific risk perceptions and cultural nuances, healthcare professionals can develop and implement more effective, culturally sensitive health promotion and disease prevention strategies. This tailored approach can lead to better patient outcomes and a more equitable healthcare system.

We aimed to examine the association between team functioning in primary care and patients’ self-efficacy and quality of life. We also examined the moderation effect of multimorbidity and social vulnerability on this association.

Team-based care has been adopted as an appropriate model to deliver comprehensive primary care services to meet the complex needs of patients. Little is known about the association between team functioning and patients’ self-efficacy for managing chronic conditions (SEMCD) and quality of life.

We used mixed-random effect modelling to analyse secondary cross-sectional data. Data were collected in primary care practices in three Canadian regions. Dependent variables included patients’ SEMCD and quality of life. The independent variable was team functioning measured using the Team Climate Inventory scale (TCI). We also included two interaction terms: social vulnerability and TCI, and multimorbidity and TCI. Control variables included patient characteristics, patients’ experience with care and practice characteristics.

Eighty-seven practices and 1,929 patients participated in the study. Of these, 67% were female, 5% had two or more social vulnerabilities and 65% had multimorbidity. Regression analyses failed to find an association between team functioning and patients’ self-efficacy or quality of life. There was a strong positive association between team functioning and self-efficacy for people with multimorbidity (p = .005) compared to those without multimorbidity. There was also a strong positive association between team functioning and quality of life for those with two or more vulnerabilities (p < .001) but not for those with fewer vulnerabilities. The findings showed people with multimorbidity and increased vulnerabilities could benefit from well-functioning teams. Supporting better team functioning through effective communication (e.g., team meetings) and care coordination; encouraging full participation of all team members in service delivery; and establishing clear team objectives, roles and responsibilities can better meet the needs of complex patients.

To identify key factors associated with varying levels of Medicare’s Chronic Care Management (CCM) programme implementation in rural primary care practices in the United States.

Despite demonstrated benefits for both patients and providers, CCM implementation remains low nationwide. While previous studies have examined payment-related challenges, limited research exists on other implementation factors such as leadership engagement, organizational culture, and provider training, particularly in rural settings.

This mixed-methods study examined CCM implementation across six rural primary care practices in Wyoming. Thirteen healthcare professionals participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Practice performance data collected over three consecutive months were used to categorize sites as high or low implementers based on care coordinator productivity, percentage of care coordinated, and programme sustainability. Interview transcripts were analysed using CFIR constructs to identify factors that distinguished high from low-implementing sites, with each factor rated based on its impact (positive, negative, or neutral) and strength of influence.

Three CFIR constructs strongly distinguished between high and low implementation sites: networks and communication, leadership engagement, and reflecting and evaluating. High-implementing sites demonstrated effective team communication, supportive leadership, and regular programme evaluation practices. In contrast, low-performing sites faced poor communication, minimal leadership support, and weak feedback mechanisms. Further research is needed to examine the effectiveness of targeted interventions designed to strengthen these organizational factors in rural primary care settings, particularly focusing on developing scalable strategies that account for resource limitations and geographic isolation.

The urban First Nations population in Australia is rapidly increasing. The health policy and research focus on urban First Nations Australians, however, is limited. To contribute to addressing this situation, The University of Queensland Poche Centre for Indigenous Health (UQ Poche Centre), a First Nations-led health research centre, is working closely with urban Aboriginal Community-Controlled Health Services (ACCHS) across Australia.

Our study examined urban ACCHSs stakeholders’ perspectives of the health and wellbeing of urban First Nations Australians and identified their priorities for a national Indigenous urban health research agenda.

Ten stakeholders were recruited for in-depth interviews from ACCHS that were members of the Research Alliance for Urban Community-Controlled Health Services (RAUCCHS), a partnership between the UQ Poche Centre and urban ACCHS focused on achieving equitable health outcomes for urban First Nations Australians. Six stakeholders identified as First Nations Australians. Interviews were audio-recorded and transcribed verbatim. Interview data were analysed using inductive thematic analysis.

Stakeholders highlighted a lack of research focused on the health of urban First Nations Australians. Specific priority areas they identified for an urban First Nations health research agenda were: evaluating the effectiveness and adaptability of Indigenous models of care, strengthening care pathways between ACCHS and specialist services, examining the intersection of cultural identity, racism and determinants of health, and greater investment in Indigenous research governance structures and processes.

There is a clear opportunity for researchers to engage with RAUCCHS members to establish a body of urban First Nations health research in Australia that responds to their research priorities.

To investigate the decision-making processes of nurse prescribers in general practice when managing acute episodes of illness in patients with multimorbidity.

Nurse independent prescribers in UK general practice are facing increasing complex clinical decision-making when assessing patients presenting acutely with undifferentiated and undiagnosed conditions as multimorbidity and polypharmacy becomes increasingly common. This qualitative study investigated the decision-making processes of nurse prescribers in general practice when managing acute episodes of illness in patients with multimorbidity.

Fourteen general practice nurse prescribers were recruited through purposive sampling. Think aloud in response to staged vignettes was used followed by semi-structured interviews. Thematic analysis was used to analyse think aloud and interview data.

Participants were experienced nurses with a range of clinical exposure and training who mostly made appropriate diagnostic and prescribing decisions. Pockets of expertise were revealed which reflected participants’ clinical experience, but there was a high rate of referral to the GP for some vignettes. Participants’ decision-making was underpinned by both analytical and intuitive processes, the quality of which was dependent on their individual knowledge and experience. A reliance on pattern recognition, aligned to intuitive decision-making, to determine the content of the consultations was identified as an area of risk and showed all participants to be inconsistent in their identification of complex factors. Omission of these factors could have important implications for prescribing decision-making. Organizational issues such as time-limited clinics also shaped the content of participants’ consultations, encouraged a limited, problem-focused approach, and reduced the opportunity for mentorship. Comprehensive knowledge, clinical experience, and mentorship are critical to ensure nurse prescribers make optimal decisions in the context of patients with multimorbidity. A team approach to the management of acute presentations in these patients is recommended to improve patient experience and maximize nurse prescribers’ contribution to the general practice workforce.

Smartphones have become essential, making our daily lives more manageable; however, excessive use may cause problems. University students are particularly vulnerable to smartphone addiction. This study examines the relationship between smartphone addiction and health-promoting lifestyles among university students.

A cross-sectional study was conducted with 911 students at Dokuz Eylul University, Izmir, Turkey. Data were collected via Smartphone Addiction Scale-Short Version (SAS-SV) and Health Promotion Lifestyle Profile II (HPLP II). The printed forms were used, and the researcher administered the survey in person and recorded the responses.

Prevalence of smartphone addiction was 34.1%. Several factors were significantly associated, including female gender (p = 0.049), being single (p = 0.042), self-perceived smartphone addiction (p < 0.001), daytime sleepiness (p < 0.001), and poor sleep quality (p < 0.001). Students with smartphone addiction had significantly lower HPLP II scores (p = 0.001).

Logistic regression analysis showed that gender was no longer a significant factor. Those without a partner (OR: 1.47, 95% CI: 1.07–2.03), those who considered themselves smartphone addicts (OR: 6.86, 95% CI: 4.99–9.42), and those with daytime sleepiness (OR: 1.52, 95% CI: 1.08–2.14) had higher odds of smartphone addiction. Higher HPLP II scores were protective against smartphone addiction (OR: 0.99, 95% CI: 0.98–0.99).

This study highlights that students with smartphone addiction engage in less health-promoting behaviours and experience poor sleep quality and daytime sleepiness. Self-perceived smartphone addiction was strongly associated with actual addiction, while a healthier lifestyle appeared to have a protective effect. There is a need for strategies to promote healthy habits and reduce smartphone addiction among university students.

Palliative care development in primary care is crucial worldwide. This study reports on the secondary outcomes of a study that evaluated whether a complex intervention in primary care for patients with palliative care needs impacted their healthcare utilization.

A before-after study was conducted with family physicians and patients with palliative care needs. Physicians received palliative care training and implemented a new primary palliative care consultation model. Healthcare utilization in the 12 weeks before, during, and after the intervention was compared.

We analysed healthcare utilization for 33 patients with advanced disease. Pre-intervention, there were high rates of no medical consultations, emergency visits, hospital admissions, and outpatient referrals (84.8%, 75.8%, 81.8%, and 84.8%, respectively). Despite slight reductions during and after the intervention, the differences were not statistically significant.

The reduction in healthcare utilization was not statistically significant, but the data inform sample size calculations for future economic analyses.

ClinicalTrials.gov ID – NCT05244590. Registration: 14th February 2022.

The increasing diversity of the UK’s population, along with significant inequalities in health outcomes among diverse cultural and ethnic groups, highlights the critical need for healthcare providers, including physiotherapists, to deliver culturally competent care. Research demonstrates that cultural competency (CC) in healthcare can enhance patient outcomes, improve treatment adherence, and address health inequalities. This quality improvement project aimed to evaluate the impact of a brief training intervention on perceived CC among physiotherapists engaging in cross-cultural, clinical encounters.

The design of this project was informed by principles of the Plan-Do-Study-Act (PDSA) cycle. Musculoskeletal physiotherapists voluntarily participated in this educational intervention by completing a CC e-learning course developed by Health Education England. A retrospective evaluation method was used, where participants rated their awareness, knowledge, and skills in providing care to diverse patient groups after completing the training as compared to before.

The pre-and post-training responses assessed three constructs of CC: awareness, knowledge, and skills. Significant increases were observed in the mean scores for each construct, as well as in the overall aggregate CC score, indicating measurable improvements following the training.

Improvement in CC is viable and achievable through targeted training. CC is a lifelong, dynamic process that requires ongoing education. Therefore, further PDSA cycles are recommended with more advanced educational sessions. Additionally, future projects should assess the impact of enhanced CC on patient outcomes and experiences. Cultural competency must encompass cultural issues beyond racial and ethnic differences.

This study analyses the relationship between fear of stigma and bypassing primary ART facilities by ART clients in the Upper East Region of Ghana.

Methodology: The study employed an exploratory case study design, involving 52 participants of: ART clients (n = 37), nurses (n = 7), a counsellor (n = 1), cadres (n = 2), pharmacists (n = 2) and data managers (n = 3) through convenient and purposive sampling techniques. Data was collected using semi-structured interview guides and analysed using a thematic framework.

The study provides ample evidence of the occurrence of stigma-driven bypassing of primary ART facilities by clients. The analysis shows entrenched cultural norms and values and the population’s low awareness of the efficacy of ART fuel the processes of stigma and discrimination towards ART clients.

We acknowledge the following limitations and strengths: convenient and purposive sampling procedures may not represent the views of all ART clients on bypassing primary facilities. Sensitive nature of HIV and the location of ART centres, coupled with time constraints in probing into all ART bypassing issues. Yet, given the depth of the issues presented and the scope of participants and ART facilities, we believe relevant data was generated to address the research question.

An integrated approach could be used to address the drivers of stigma and discrimination focusing on awareness creation to undo the entrenched negative cultural beliefs around HIV transmission, and implement anti-HIV stigma legislation to eliminate prejudice towards PLHIV.

This exploratory project aimed to develop online learning materials with interactive narratives for supporting persons living with dementia, with particular focus on initial diagnosis and helping children to understand changes which may occur.

Dementia is a range of neurological conditions that cause the ongoing decline in brain function, manifesting as loss of memory, language, and problem-solving abilities. Over 55 million people worldwide are living with dementia, straining health and social care resources in their ability to provide information, care, and support for the family. There is a need for easily accessible, high-quality, and nationally scalable resources for dementia support for this growing population.

Twine was used to produce online digital storytelling media titled ‘Grandad Forgot My Name’, following the narrative of dementia care for family members. Design, theming, artwork, and story pathways reflected key aspects of dementia and dementia care to facilitate additional support for readers, and health and social care workers. Usage statistics were monitored and readers answered evaluative surveys with numerical scoring and descriptive free responses. Story pathways and information were continuously updated following survey responses.

Twine and interactive storytelling had potential to reach a wide audience at minimal cost, bridging the gaps between initial concerns, diagnosis, and appointment. However, there were issues with stakeholder adoptability and uptake when sharing materials which must be resolved in full-scaled outputs. Grandad Forgot My Name successfully demonstrated key design and logistical considerations when creating support resources of national impact, with cross-generational communication and reader-centric design optimising engagement.

This study aimed at investigating the clinical, individual, and systemic factors influencing paediatricians’ and family physicians’ clinical decision-making process in the vaccination of children during infection from the physician’s perspective.

A qualitative study through semi-structured in-depth interviews was conducted among 10 paediatricians and 10 family physicians working in Ankara, Türkiye. The audio-recorded interviews were translated into written texts, and the obtained data was analysed using the thematic analysis method proposed by Braun and Clarke.

Four main themes were identified in of thematic analysis: (I) Impact of clinical conditions on vaccination decisions, (II) attitudes of families and their communication processes with physicians, (III) impact of practice settings and institutional factors, and (IV) vaccine postponement and compensation approaches. It was observed that the decision-making processes of the paediatricians were mainly based on the clinical evaluation criteria, while family physicians considered the expectations of the families and institutional conditions. Also, the importance of establishing effective communication with vaccine-hesitant families has been emphasized by both groups of physicians.

In the immunization of infected children, decision-making is shaped in addition to medical facts in relation to the parental attitude, organizational factors within health institutions, and personal experiences of medical staff. Decisions of paediatricians are largely grounded in medical facts, whereas family practitioners assess that social and organizational factors are of higher importance. Improved adherence to medical guidelines and communication competencies of medical professionals can contribute towards medical practice consistency.

Veterans Affairs Medical Centers offer multiple weight-loss treatments, including a comprehensive lifestyle intervention program (i.e., MOVE!), anti-obesity medications (AOMs) and bariatric surgery. Yet, most eligible veterans do not receive these treatments.

To describe the design, rationale, and planned evaluation of a comprehensive Weight Management and Metabolic Health program (WMMHP), consisting of (1) weight-focused visits with physicians or pharmacists trained in obesity medicine; (2) patient-centered use of available weight-loss treatments; and (3) coordinated, team-based care.

This is a quality improvement program implemented within the VA Ann Arbor Healthcare System. WMMHP eligibility criteria include body mass index (BMI) ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 and ≥ 1 weight-related condition and participation in the MOVE! program. We plan to conduct an 18-month retrospective program evaluation using a propensity-matched cohort analysis to estimate the added benefit of WMMHP vs. MOVE! alone. The primary outcome will be mean change in weight at 18 months after baseline. Secondary outcomes will include mean weight loss at 6, 12, and 24 months, percentage of patients achieving thresholds of ≥ 5%, ≥ 10%, and ≥ 15% weight loss, initial prescriptions for and refilled prescriptions as a measure of adherence to AOMs, and referrals to, engagement with, and completion of bariatric surgery. We will also examine between-group differences in health system resource utilization.

The WMMHP is an innovative approach to improving treatment and outcomes for veterans with overweight and obesity. If effective, its components may inform obesity care delivery in VA and non-VA settings.

Poverty is a risk factor for poor health. We sought to determine the practices, barriers, knowledge and comfort with poverty screening and intervention amongst family physicians (FPs), family medicine residents (FMRs) and family nurse practitioners (NPs) in Saskatchewan, Canada during the COVID-19 pandemic.

A survey was distributed by email and newsletters to FPs, FMRs and NPs in Saskatchewan during 2022.

Eighty-three FPs, 35 FMRs and 25 NPs responded. Time, patient factors, practitioner knowledge and availability of community resources/services were reported barriers. Comfort discussing government benefits with patients was low, with slight differences amongst provider groups (p =.042). Thirty-one (40.3%) FPs, 7 (20.6%) FMRs and 17 (68.0%) NPs had referred a patient to a government benefit. Eight (6%) respondents used the Poverty Screening Tool.

Further research and training is needed to integrate poverty screening and intervention into primary care, given practitioners’ role as healthcare’s initial point of contact.

Identifying diagnoses from noncoded healthcare visit records presents logistical challenges when large number of records are screened. This study aimed to develop a screening process to identify otitis media (OM) diagnoses in free-text primary care visit records.

The free-text primary care records of 200 children aged 0 to 4 years were reviewed independently by three clinicians to determine whether OM was a diagnosis considered during each visit. Terms (abbreviations, words, and phrases) identifying visits where OM was considered or excluded were documented. These terms were used to design a software algorithm subsequently used to detect OM diagnosis within these primary care records. The diagnostic performance of the software algorithm was determined against the gold standard clinicians’ review and described using sensitivity, specificity, predictive values (PVs), and likelihood ratios (LRs) with 95% confidence intervals (CIs).

The 200 children had 10,034 primary care visits. Clinician review identified 917 (9%) visits where OM was considered, and 9117 (91%) visits where OM was excluded. The software algorithm identified 801/917 visits where OM was considered and 8705/9117 visits where OM was excluded. The algorithm sensitivity was 87% (95% CI 85–89), specificity 96% (95% CI 95–96), positive PV 66% (95% CI 63–69), negative PV 99% (95% CI 98–99), positive LR 19.33 (95% CI 17.54–21.31), and negative LR 0.13 (95% CI 0.11–0.16).

Software algorithms can assist in screening healthcare visit records. When combined with clinician review, they enable accurate identification of OM visits from non-coded records.

This study aimed to develop a transparent district-level Maternal and Child Health (MCH) index for Uttar Pradesh (UP), India, using a hybrid methodological framework integrating Analytic Hierarchy Process (AHP), Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), and Geographic Information Systems (GIS), to support spatially targeted and equitable health planning.

MCH is a key indicator of equity and effectiveness within health systems, directly impacting the wellbeing of mothers and children. Despite global efforts, many low-and middle-income countries continue to face preventable maternal deaths and child illnesses. In Uttar Pradesh (UP), substantial inter–district disparities in MCH outcomes persist but are often masked by state-level averages, hindering targeted policy and resource allocation.

We applied a hybrid Multi-Criteria Decision-Making (MCDM) framework. AHP was used to assign weights to nine key MCH indicators covering antenatal care, skilled birth attendance, child immunization, and nutrition based on National Family Health Survey (NFHS-5, 2019–21) data across 75 districts. TOPSIS was then employed to rank districts by overall MCH performance. GIS was used to visualize spatial disparities and identify clusters of high and low performance.

The MCH Index revealed substantial spatial disparities across UP. Districts such as Barabanki, Mahamaya Nagar, and Unnao ranked highest, while eastern UP and Bundelkhand showed lower performance. AHP assigned the highest importance to skilled birth attendance (22%) and antenatal care visits (22%). TOPSIS rankings highlighted gaps in maternal health services in socioeconomically marginalized districts. GIS mapping identified clusters of vulnerability linked to infrastructure and poverty. The AHP-TOPSIS-GIS framework provides a replicable method for sub-state MCH assessment, enabling policymakers to prioritize underserved districts and reduce geographic health outcomes. The findings underscore the need for decentralized, equity-focused strategies tailored to local contexts. Future research should incorporate temporal changes and socio-environmental factors to strengthen planning and monitoring.

The aim of this study was to explore the acceptability of an educational video among primary care clinicians as a tool to promote the use of stigma-free language in interactions with individuals with type 2 diabetes (T2D).

The language used by primary care clinicians in interactions with adults living with T2D can contribute to perceptions and experiences of diabetes-related stigma and be a barrier to achieving and sustaining glycaemic targets. In 2017, the American Diabetes Association (ADA) and the Association for Diabetes Care & Education Specialists (ADCES) issued a guidance paper with recommendations to promote stigma-free communication about diabetes.

The educational video, developed by the research team, presents two versions of a vignette in which a nurse practitioner interacts with an adult with T2D in a primary care setting. The first version of the vignette features the nurse practitioner using stigmatizing language as outlined in the ADA and ADCES guidance paper; the second demonstrates the use of stigma-free language by the nurse practitioner. A narrator highlights the linguistic differences. The study participants, comprising physicians (n = 8), nurse practitioners (n = 9), and physician assistants (n = 1), were recruited through professional networks and via online forums and listservs for healthcare professionals. Participants viewed the educational video and were interviewed via Zoom by a research team member using a semi-structured interview guide. The transcripts of the interviews were analysed using a qualitative descriptive approach.

Three main themes emerged from the data: aligning video content with existing attitudes and beliefs, reducing the use of stigmatizing language, and increasing the use of stigma-free language. Findings suggest that an educational video promoting the use of stigma-free language in interactions with adults with T2D is acceptable among primary care clinicians.

The aim of this study is to investigate family physicians’ approaches to hoarseness (dysphonia), clinical decision-making, patients’ perceptions, and structural barriers in the healthcare system using qualitative methods.

Qualitative design was used. Research was reported in line with COREQ (32 items) and EQUATOR (SRQR) guidelines. Semi-structured telephone/internet interviews were conducted with 17 family physicians working primary care in Türkiye. Participants purposively sampled interviews were audio-recorded, transcribed, coded using thematic analysis, and developed themes.

The analysis revealed four main themes: clinical assessment and differential diagnosis, referral criteria and specialist referrals, patient perception and knowledge level, health system and structural barriers. Demographic analysis determined that veteran doctors were more sensitive to malignancy, junior doctors highlighted systemic deficits, female doctors highlighted patient behavior, while doctors who practiced in rural areas highlighted structural issues.

Family physicians’ handling of hoarseness is not only dependent on clinical data but also on patient opinion and the health system’s conditions. For productive primary care management of hoarseness, it is recommended to (i) design guidelines and training for family physicians, (ii) increase patient education on voice hygiene and voice health, and (iii) establish health policies enhancing specialist accessibility.

To explore nurses’ perceptions regarding their knowledge, degree of autonomy, and the difficulties encountered in managing diabetic foot in Primary Care.

Diabetes mellitus is a chronic condition with a high prevalence in Spain, predominantly type 2. One of its most serious complications is diabetic foot disease, affecting between 19% and 34% of patients and associated with considerable morbidity and amputation risk. Primary Care, particularly nursing professionals, plays a pivotal role in the prevention, assessment, and management of diabetic foot. However, institutional, methodological, and personal barriers continue to affect care quality.

A descriptive, cross-sectional observational study was conducted using quantitative and qualitative methods. A validated ad hoc questionnaire was administered to 176 nurses from the Murcian Health Service participating in a blended learning course on diabetic foot. Variables assessed included professional autonomy, knowledge, dressings use, clinical documentation, training, and perceived challenges. Qualitative analysis was based on open-ended responses using content analysis.

A total of 88.1% of nurses reported autonomy in performing foot examinations; however, only 45.5% managed wound care independently. Just 19.9% considered themselves sufficiently trained, while 42.6% felt confident in selecting dressings appropriate to the healing phase. Although 56.8% regularly completed specific clinical documentation forms, many still expressed uncertainty about dressing use. Qualitative analysis identified five key barriers: lack of knowledge, patient complexity, institutional constraints, issues of authority and communication, and professional insecurity. These findings provide a current picture of persistent barriers in diabetic foot care and reinforce the need for targeted training and institutional support.

The study aims to understand the perceptions of deprescribing in primary care for patients with a limited life expectancy.

In the setting of limited life expectancy, medications may become inappropriate when the possible harms of use outweigh the benefits. Whilst the cessation of potentially inappropriate medications is associated with improved patient outcomes, incorporating this process into routine primary care is poorly enacted.

Qualitative interview study performed in primary care settings in the Netherlands, including primary care health professionals, patients with limited life expectancy, and their caregivers. Semi-structured interviews were conducted and analysed using inductive thematic analysis.

Three key themes emerged: (1) facilitating well-being, (2) preventing harm, and (3) dealing with uncertainty. A key goal of mediation use is to facilitate well-being, although the perceptions of this effect may not always match the reality due to changed clinical circumstances. The decision to continue or stop medication is influenced by the wish to prevent harm and to what extent participants find ways to deal with the uncertainties facing them.

Reluctance to deprescribe medications is often related to uncertainties around ceasing medications, lack of clear clinical guidance, and the evolving situation of advanced illness. Integrating these discussions into routine primary care for patients with chronic and incurable illnesses may assist patients and healthcare professionals to address issues around medication use in a proactive manner and promote advance care planning discussions.