The DiRePal model understands dignity at the end of life as relational and temporal, shaped by recognition, narrative continuity, and prudent listening. This study explores how patients with advanced cancer, informal caregivers, and physicians understand and experience dignity, providing empirical foundations for the model.

A multicentre qualitative study comprised six semi-structured focus groups involving oncology patients (n = 10), informal caregivers (n = 14), and pulmonology/oncology physicians (n = 15), conducted via a secure digital platform between April and November 2025 with IQVIA Portugal. Transcripts underwent reflexive thematic analysis, with independent initial coding, discussion-based consensus, and researcher reflexivity. Given participants’ clinical fragility, member checking was not undertaken; credibility relied on triangulation, thick description, and an audit trail.

Six themes emerged: personal understanding of dignity, narrative flexibility, negotiating technical rationality and relational care, temporal sensitivity, professional reciprocity, and digital/structural integration. Dignity was inseparable from personal recognition, interpersonal gestures, and listening within time-constrained encounters. Physicians’ emotional overload and insufficient institutional support compromised their dignity and, indirectly, patients’; caregivers frequently rendered themselves invisible. Patients associated dignity with respect, autonomy, and relief of suffering, while depersonalised or fragmented care eroded it.

These findings ground a relational–temporal account of dignity in reciprocal recognition between patients, caregivers, and clinicians across shared, unevenly experienced time. Listening, temporal prudence, and recognition of clinicians’ vulnerability should be clinical priorities, alongside cautious, relationally framed integration of digital tools.

This study aimed to explore how individuals with complex multimorbidity perceive and experience the management of their health in everyday life and healthcare encounters.

Patients with two or more health conditions may be challenging for general practitioners (GPs) who must provide adequate treatment(-s) in a healthcare system structured mainly around single-disease models. For patients, the lived experience of this multimorbidity can be demanding, as it often involves managing multiple appointments, medications, and medical advice alongside everyday life. This situation may be particularly challenging for patients who live with multiple physical and mental health conditions.

Semi-structured individual interviews with eight individuals with complex multimorbidity living in Denmark. Analysis was guided by thematic analysis.

The analysis resulted in two main themes. First, ‘Multiple diagnoses – not multimorbidity’ describes how the participants did not expect overall continuity across diagnoses but appreciated recognition of the cumulative burden of multimorbidity. They expected continuity within each speciality and developed agentic strategies to achieve this. Some were successful; others were not. Second, ‘Managing treatment and illness in everyday life’ describes how the participants navigated tensions between medical recommendations and personal priorities as they deliberately pursued valued activities at the expense of their long- or short-term health. A professional lifeline, was a significant support for the participant. This person was often the GP. These findings underscore the active role of patients and the GP’s role in recognizing their resources to develop patient-centred care that is responsive to and realistic for the individual patient.

This article examines how general practitioners (GPs) in Italy and Spain manage patients with mental health needs in daily primary care practice, and how their discretionary choices shape the substantive reach of universal access to care.

Modern healthcare systems in Italy and Spain formally guarantee universal access to primary care. However, mental health services in primary care reveals persistent gaps between this normative principle and everyday practice. Drawing on Lipsky’s Street-Level Bureaucracy (SLB) theory, GPs are understood as frontline professionals whose discretion operates within, and is shaped by, conditions of resource scarcity, time pressure, and limited access to psychosocial services.

A qualitative cross-national design was employed, including 42 semi-structured interviews with 20 GPs and 22 patients with mental health needs in Spain and Italy, conducted between June and November 2022. Data were analysed through an inductive-deductive coding process.

Two principal patterns of discretionary practice emerged. First, GPs exercise discretion differentially by patient age: investing in psychoeducation, counselling, and motivational support with younger patients, while moving more rapidly towards pharmacological management with older patients. This age-based categorization operates as a coping strategy that shapes patients’ candidacy for psychosocial versus pharmacological care. Second, GPs actively normalize psychological distress as a counter-medicalization strategy, primarily with younger patients. Despite significant institutional differences between the two healthcare systems, these patterns converge across Italy and Spain, suggesting they reflect structural features of the SLB role under resource scarcity rather than system-specific dynamics.

This study aimed to explore patient perspectives on standardized screening for social needs within the context of primary care in Canada.

Social determinants of health significantly influence patient health outcomes. While standardized screening for patient social needs has gained momentum, patient perspectives on the utility of said screening, particularly within the Canadian context, remains underexplored.

Semi-structured interviews were conducted with participants aged 18 and older (n = 195), recruited from a larger multi-site study, using purposive maximum-variation sampling across four Canadian provinces (Ontario, Manitoba, Saskatchewan, and Newfoundland and Labrador). Questions asked during the interviews focused on financial well-being (ability to afford basic needs), housing status, social well-being, transportation, ability to afford utilities, and employment status. These interviews followed another study component where participants were asked to complete a short social needs questionnaire (the SPARK tool). Data was analysed using a thematic content analysis. Five themes were generated, including (1) openness to screening for social needs, (2) value in healthcare providers knowing patients’ social needs, (3) overall scepticism and trust/distrust in the healthcare system and professionals; (4) potential for harm; (5) meaningful engagement and provider training on social needs.

Participants were generally comfortable being asked about their social needs but stressed the importance of privacy, especially regarding financial well-being (ability to afford basic needs and extended health-care related expenses), as well as clear usefulness of the data and building physician-patient trust. Participants were generally open to social needs screening, though discomfort emerged when discussing race, employment, housing, and financial well-being, largely driven by concerns about privacy, trust, and data use. These findings highlight the importance of transparent communication, robust data governance, and explicit informed consent to support acceptable and effective implementation of social needs data collection.

To explore general practitioners’ and radiologists’ expectations of ankle radiography for chronic complaints.

Ankle complaints are a frequent reason for general practitioner (GP) consultations and ±20% of ankle radiography requests are for chronic complaints. It is unknown what GPs and radiologists expect from ankle radiography for chronic complaints.

A qualitative study was conducted with GPs and radiologists. Semi-structured focus group discussions were held online or live until data saturation was reached. The topic guide included: reasons for radiography, content of requests and reports, and the impact of results on patient management. The recorded interviews were transcribed and subsequently coded inductively in Max-QDA.

Five focus groups with 24 GPs and 3 focus groups with 11 radiologists were held. Radiologists focussed more on urgent diagnoses that were less considered by GPs for their rareness. GPs indicated to request ankle radiography more often for patient-, physician-related and organizational reasons than for medical indications. Radiologists expect requests to include a specific question accompanied by applicable clinical information including a specific pain location. GPs in their turn expect a short conclusion of the report answering their question.

GPs and radiologists have different expectations of radiography for chronic ankle complaints. Important in GPs’ rationale behind requesting ankle radiography for chronic complaints are non-medical factors and prevalence of ankle disorders, while radiologists also focus on more rare diagnoses than GPs. More research on the added value and accuracy of ankle radiography for chronic complaints in primary care settings is necessary.

To examine school food service directors’ (FSD) perceived barriers and facilitators to increase scratch cooking as a strategy to reduce ultra-processed foods (UPF) in school meals.

A mixed-methods study design was used, incorporating semi-structured interviews and surveys. A Community Advisory Board provided input on the study design, interview guide and interpretation of results. Interviews were audio-recorded, transcribed verbatim, de-identified and double-coded. A hybrid thematic analysis was conducted, integrating emergent and a priori themes based on the socio-ecological model.

California San Joaquin Valley, USA, from January to June 2024.

Twenty FSD were randomly selected from a stratified sample of San Joaquin Valley school districts, categorised by locale (rural/urban) and whether they received a California supplementary funding award requiring at least 40 % of school meals to be freshly prepared.

Key barriers to increasing scratch cooking in school meals included labour costs, staff shortages, inadequate kitchen infrastructure and food procurement challenges, with many districts relying on UPF. State and federal funding supported scratch cooking, but limited kitchen space and funding uncertainty hindered sustainable changes. While some FSD identified student preferences as a challenge, others described successful strategies to engage both students and parents to increase acceptance of scratch-cooked meals and boost participation in school meals.

Given the current momentum at the federal, state and local levels to reduce UPF in school meals, this study provides timely insights to guide policies and practices that support the transition from UPF to scratch-cooked meals.

Community-based programmes exist to support older people and their caregivers remaining out of hospital on discharge. Little is known about how consumers of a community-based programme perceive the different components provided during community TCP.

To explore how older people and caregivers perceive how a transition care programme (community-based TCP) influenced older people staying at home following hospital discharge. Secondly, to assess if experience of TCP could be explained by the person-centred care model (PCC).

Both (i) older people and (ii) caregivers were interviewed at a single metropolitan health setting. Experiences leaving hospital, the challenges, and the TCP components identified that supported or hindered consumers to remain at home were explored. Thematic content analysis was used to examine the two consumer groups separately. Secondarily, a mapping exercise assessed if PCC could be identified during analysis.

Fifteen interviews (older people (n = 8), caregivers (n = 7)) were conducted between April 2019 and January 2021. There were seven older people themes including, (i) Limited understanding of TCP content, (ii) Things are different once home, (iii) Developing action plans for continence care, (v) Developing action plans for walking. Three caregiver themes including, (i) Challenges with the discharge home on many fronts, (ii) Getting the right resources in the right way, were found. Most thematic sub-groups could be mapped to PCC constructs (6/9 (67%) caregiver, 5/9 (56%) older people). Health and social care resources are acknowledged, particularly equipment and information access, however gaps exist in how TCP fully aligns with PCC, according to consumers.

Managing Cancer and Living Meaningfully (CALM) therapy may be a beneficial intervention for addressing death anxiety in caregivers yet has not been formally evaluated in this population. The purpose of this Phase 1a Define trial was to evaluate the suitability of CALM for caregivers of patients diagnosed with malignant glioma using qualitative stakeholder interviews prior to pilot testing.

Twenty-two bereaved caregivers participated in a focus group and completed subsequent caregiver-reported outcome measures. During the focus group, caregivers received information about CALM and provided feedback on the intervention’s relevance and recommendations to improve its content and delivery for the caregiving experience. A team of coders qualitatively analyzed responses using thematic, deductive, latent analysis (kappa = 0.86).

Results suggest that CALM is highly relevant to the caregiving experience and may benefit caregivers emotionally, increase preparedness and self-efficacy in their role, improve their communication with the patient, and provide a unique opportunity to receive specialized care. Potential hurdles for participation included limited time and energy, concerns about burdening the patient by sharing their emotions, and worries that their loved one would not be emotionally or cognitively capable of participating. Participants also recommended additional content areas relevant to caregiving (i.e., burden and bereavement) and provided suggestions to improve CALM’s delivery (timing, initial presentation, session format, and logistics).

Participants’ feedback was largely positive and supports piloting an optimized CALM protocol among malignant glioma caregivers. Further research is needed to determine CALM’s effectiveness in caregivers of patients with malignant gliomas.

Weight gain is a common, distressing side-effect of antipsychotic medication prescribed for people with severe mental illness. National guidance for antipsychotic-induced weight gain (AIWG) encourages early intervention and physical health monitoring; healthcare professionals (HCPs) often struggle to implement these recommendations in routine care.

To explore how HCPs understand and respond to AIWG for patients.

This realist evaluation, part of the RESOLVE project, builds on a realist synthesis. Thirty HCPs participated in realist interviews. A programme theory with nine context–mechanism–outcome configurations (CMOCs) was generated, explaining how HCPs perceive non-pharmacological care provision for patients with AIWG. Clinical and lived experience stakeholders reviewed and refined the theory and CMOCs.

The nine CMOCs spanned three areas: (a) systemic and professional challenges; (b) strategies to enhance individualised and meaningful support; and (c) the role and limitations of non-professional support. HCPs described how lack of training, siloed services and system-level constraints limited their ability to offer integrated care. They highlighted the importance of relational continuity, early and tailored conversations, and alignment with patients’ values and motivations. Peer and family support were valued, but structural barriers undermined their consistent implementation.

AIWG was experienced as compromising professional values for HCPs working in mental health settings. Person-centred care was often undermined by fragmented systems, role ambiguity and insufficient training. These issues require investment in professional development, structural integration, and relationship-based approaches that support timely, collaborative action.

The 2022 floods in Pakistan marked one of the country’s most severe natural disasters, displacing approximately 33 million people, causing significant loss of life, and devastating infrastructure. While initial relief efforts focused on immediate food, shelter, and medical support, the transition to long-term rehabilitation has proven complex and prolonged, often overshadowed by emerging crises.

A mixed-methods study was conducted between September 2022 and September 2024 in flood-affected districts of Sindh province, Pakistan. Semi-structured interviews were conducted with 6 community leaders from 4 severely affected districts (Naushehro Feroze, Sukkur, Tando Allahyar, and Dadu). Operational records from the Humanity Initiative (HI), a student-led NGO, were also reviewed to document relief activities, geographic reach, volunteer deployment, and patient outcomes.

HI deployed over 150 medical students and health care professionals across 6 districts, establishing emergency medical camps that served more than 12,000 individuals. Thematic analysis of community leader interviews identified 5 key domains of persistent need: access to clean water, housing, food security, mental health, and educational continuity.

Student-led organizations play a vital complementary role in disaster recovery, particularly in remote and underserved areas. Sustained, integrated rehabilitation addressing mental health, economic recovery, and education is essential. Collaborative frameworks between student-led NGOs, larger organizations, and policymakers are needed to ensure long-term resilience.

Women with first-episode psychosis (FEP) may experience distinct clinical, reproductive and social challenges, yet their experiences of psychosis care remain underexplored. Greater understanding of women’s perspectives is needed to inform gender-responsive service provision.

To explore how women make sense of their experience of psychosis care, to identify areas where gender-specific needs were unmet and to highlight priorities for improving care for women experiencing FEP.

This qualitative study employed semi-structured interviews with women who had experienced FEP and received care through early intervention in psychosis and adult community mental health services (N = 15). Data were analysed using reflexive thematic analysis.

Four overarching themes were identified: (a) violations of personhood and bodily integrity; (b) invisible menstrual and reproductive health in mental healthcare; (c) women-specific barriers to accessing and sustaining care; and (d) moving towards better care for women with FEP. Women described feeling unsafe in mixed-gender in-patient settings, experiencing unmet reproductive and menstrual health needs and navigating caregiving responsibilities that complicated engagement with care. Findings informed a framework of recommendations for improving gender-responsive psychosis care.

This study provides one of the first in-depth qualitative examinations of women’s experiences of FEP care. Women described how their experiences were shaped by issues of safety, autonomy, reproductive health and gendered expectations that remain insufficiently recognised within current service models. These findings highlight persistent gaps in sex- and gender-responsive psychosis care, and support the development of services that more effectively address women’s safety, reproductive health and caregiving needs.

This study aimed to explore patients’ experience of active transcutaneous hearing implants and identify factors influencing outcomes and access to care.

A qualitative study was conducted at a tertiary referral centre. Adult recipients of active transcutaneous hearing implants were invited to complete open-ended questionnaires. Responses were analysed thematically using NVivo® software until saturation was achieved.

Thirty-one responses were analysed (69 percent response rate). Six themes were identified: impact of hearing loss; pre-operative experience; positive impact of the hearing implant; associated drawbacks; variation in audiology support; and limited awareness of hearing implants. Most patients reported significant improvements in hearing, confidence and quality of life. However, experiences were influenced by prior device use, expectations and individual circumstances. Limited clinician awareness was repeatedly identified as a barrier to timely access.

Active transcutaneous hearing implants provide substantial patient-reported benefit. Improving clinician awareness and managing expectations may enhance patient experience and access to care.

Autistic women and birthing people (AWBP) are at heightened risk of perinatal mental health difficulties such as perinatal anxiety and depression, yet little is known about their experiences of support from specialist perinatal mental health teams (SPMHTs).

We aimed to understand the experiences of AWBP engaging with support from SPMHTs.

We conducted semi-structured interviews with 18 participants from 4 SPMHTs in England to explore their experiences and perceptions of care. We used codebook thematic analysis to identify and develop themes that captured and explained patterns within the data.

We identified three themes: (a) seeing the whole person: for many, SPMHT involvement was the first time autism was recognised or explored in a mental health context. Participants valued opportunities for formal assessment, which supported self-understanding and highlighted the need for integrated care addressing both autistic and mental health needs. (b) Experiencing SPMHT care as an autistic person: participants valued care that accommodated their needs and preferences, particularly practical interventions, although several reported unmet needs and many found discharge challenging. (c) Ideas for service improvement: participants recommended access to autism-informed practitioners and peer groups tailored for AWBP.

This study highlights how SPMHT care that recognises and responds to the distinct needs of AWBP can make a meaningful difference. AWBP valued holistic, autism-informed perinatal mental healthcare that recognised their communication, sensory and cognitive needs. Accessing assessment for a formal diagnosis supported the development of identity as an autistic person, helping to make sense of challenges in the perinatal period.