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To (1) systematically identify tools developed to assess and address the support needs of informal carers in palliative or end-of-life care and (2) examine the extent to which socially stratifying sample characteristics have been reported following tool use.
A systematic scoping review was conducted.
Medline, CINAHL, PsycINFO, ASSIA, ProQuest Central and Web of Science databases were searched from inception to May 2024 and again in May 2025. Primary studies using any methodology reporting the development and/or use of tools to assess informal carer support needs in end-of-life care were included. Consistent with scoping review methodology, we did not conduct a quality appraisal of included studies. We extracted tool characteristics, frequency of use and sample characteristics according to PROGRESS+.
A total of 74 articles were included. From these, 24 unique tools were identified. Nine tools were used in ≥2 articles, while 15 were used only once. The most commonly used tools were the Carer Support Needs Assessment Tool (35 articles), the Family Inventory of Needs (6 articles), the Carer Alert Thermometer (5 articles) and the Spiritual Needs Inventory (4 articles). There was limited evaluation of tools beyond psychometric validation. There were substantial gaps in equity-informed caregiver sample reporting. While gender, age and country of participants were commonly reported, most other PROGRESS+characteristics were inconsistently or minimally reported.
While numerous tools exist to assess and address informal caregiver support needs, there is considerable variation in tool uptake, evaluation and the extent to which tools consider equity factors. There is a need for equity-informed tool development and clearer conceptualisation of caregiver needs, alongside efforts to evaluate tool implementation, impact and sustainability in palliative care settings.
by Ciaran M. Fairman, Alex M. Brooks, Darren G. Candow, Kylah E. Jackson, Genevieve Bottone, Brett Scott, Kenneth S. Anderson, Katie R. Hirsch, Thomas D. Cardaci, Brandon N. VanderVeen, Christine E. Blake, Tiejun Zhang, Jiajia Zhang, E. Angela Murphy
PurposeThe purpose of this trial was to assess the feasibility, acceptability and safety of a 10-week hybrid (in-clinic and virtual) resistance exercise training RET program with or without CrM in individuals treated for colorectal cancer.
MethodsTwenty-seven participants were randomized to RET plus 5 grams/day of CrM (EXSUPP; n = 13) or 5 grams/day corn-starch maltodextrin placebo (EXPLA; n = 14). RET was performed three times per week. Feasibility was assessed through recruitment, retention and fidelity (percentage of prescribed RET and supplementation completed). Acceptability was evaluated using a 5-point Likert scale, and safety was monitored through adverse event reporting. Secondary outcomes (body composition, muscular strength, physical function) were assessed pre- and post-intervention using baseline-adjusted ANCOVA models and focus group interviews.
ResultsRegistry-based recruitment identified 1378 potentially eligible individuals and 27 of 410 assessed (6.6%) enrolled, highlighting recruitment challenges. Retention was high (24/27; 88.9%). Adherence to RET and supplementation was strong (both > 85%) with no serious adverse events reported. Participants reported high acceptability for both in person and virtual components. No significant between group differences were observed for secondary outcomes; however, both groups demonstrated modest improvements in muscular strength and short physical performance battery (SPPB) scores.
ConclusionsA hybrid RET program with CrM was feasible, acceptable and well tolerated in individuals with colorectal cancer who were previously treated with chemotherapy.
Implications for Cancer SurvivorsHybrid supervised RET is safe, acceptable, and associated with modest improvements in strength and physical function among individuals treated for colorectal cancer. While creatine supplementation did not demonstrate clear additive effects in this pilot trial, further adequately powered studies are warranted.Trial Registration: NCT06420726.
To examine the relationship between resident-level (intrinsic) and facility-level (extrinsic) factors associated with pressure injury development among nursing home residents.
Exploratory, retrospective cohort design using secondary data from the Turn Everyone and Move for Pressure Ulcer Prevention study.
Data from a convenience sample of 998 residents across nine nursing homes were analysed. Resident-level factors included demographics, body mass index, comorbidities, Braden Scale scores, and clinical severity. Facility-level factors included staffing hours and location. Multivariable logistic regression identified factors associated with pressure injury development.
Of 998 residents, 61 (6.1%) developed new pressure injuries. Four significant predictors were: higher clinical severity laboratory values, underweight, fewer licensed practical nurse staffing hours, and lower Braden Scale Mobility subscale scores.
This study highlights the importance of considering both intrinsic resident-level and extrinsic facility-level factors when assessing pressure injury risk in nursing home residents. Clinical severity measures capturing individualized physiological status may provide valuable information beyond traditional risk assessment tools.
Pressure injury prevention benefits from incorporating physiological markers with traditional risk factors, enhancing early identification of high-risk residents. Effective prevention strategies address both resident vulnerability and care environment factors, particularly staffing levels. Clinical mobility assessments remain essential but gain value when integrated with physiological markers. As electronic health record use increases in nursing homes, future research can leverage these data to develop targeted interventions.
Elevated pressure injury rates in nursing homes are a persistent problem. Main findings reveal that intrinsic resident-level and extrinsic facility-level factors influence pressure injury risk. These findings enable a shift in assessment focus from primarily mobility-based to more comprehensive risk profile evaluations. Vulnerable residents will benefit from earlier risk identification that leads to targeted interventions. For healthcare systems and administrators, it highlights the importance of adequate staffing models in pressure injury prevention efforts.
Data were from resident participants in the implementation of the parent study.
Rates of mental health difficulties among girls and young women in the UK have risen sharply, and disproportionately so for those from marginalised groups. My Story and Me is a new digital public mental health intervention that uses storytelling to reduce stigma, increase awareness and support early help-seeking among girls and young women aged 14–18. The feasibility study aims to determine the acceptability of the intervention and future full trial, including assessing optimal settings and meaningful changes in the primary outcome measure (anxiety and depression).
This is an 18-month mixed-methods, uncontrolled feasibility study conducted in secondary schools, further education colleges and community organisations across the UK. We will recruit 120–180 participants. Quantitative data will be collected at baseline and 7-month follow-up. The primary outcomes are anxiety and depression, and secondary outcomes are social support, mentalising, stigma, quality of life, loneliness, empowerment, intervention acceptability, resource use and randomisation acceptability. Platform-level engagement data will assess adherence and fidelity. Qualitative interviews with young women and staff will explore acceptability, feasibility, mechanisms of change and views on trial procedures, including randomisation in a future full trial. Analysis will be descriptive and exploratory, including comparisons across settings and priority groups (LGBTQIA+, neurodivergent and those experiencing digital poverty). A framework and reflexive thematic analysis approach will be used for qualitative data. Prespecified progression criteria will inform decisions about advancing to a full cluster randomised trial.
The University College London Research Ethics Committee (0692) has approved the My Story and Me protocol. Interested participants will be required to complete an expression of interest and consent form to take part in the study, and young people under 16 years old will be required to obtain parent/carer informed consent. Results will be disseminated through peer-reviewed publications, lived experience summaries, a policy briefing and academic conference presentations.
Pressure injuries present significant challenges in clinical care, leading to severe complications such as infection, pain and delayed wound healing. They are a common chronic wound that contribute to increased morbidity, prolonged hospital stays and substantial healthcare costs. Despite national efforts to enhance chronic wound management, development of optimal treatment strategies remains a priority. The Pressure Injury Treatment Advisory (PITA) Quick Guide was developed to provide an evidence-based guide to support clinicians in pressure injury management. A survey was conducted to evaluate clinician perspectives on the usability and practicality of the Guide in acute care, residential aged care and community settings. A post-test survey was conducted on a convenience sample of healthcare professionals from three healthcare settings across metropolitan, regional and rural Australia. The survey included 5-point Likert-scale items assessing ease of use, effectiveness and integration with workflows. Three hundred and two responses were received (66.7% response rate). Clinicians expressed overwhelmingly positive perceptions, with over 95% agreeing or strongly agreeing on the guide's utility and effectiveness. No respondents strongly disagreed with any item. Residential aged care and rural clinicians rated the tool slightly higher than acute care and medical clinicians. The PITA Quick Guide was well-received across all settings, demonstrating strong potential to enhance evidence-based pressure injury management.
by Georgia Black, Reena Besa, Daniel Blumberger, Heather Brooks, Graham Collingridge, John Georgiou, Evelyn K. Lambe, Clement Ma, Bernadette Mdawar, Tarek K. Rajji, Sanjeev Sockalingam, Cara Sullivan, Quincy Vaz, Zhengbang Yao, Branka Agic
IntroductionIntegrated knowledge translation (iKT) is a collaborative research approach that emphasizes the meaningful and active participation of knowledge users throughout the research process. Evidence suggests that integrated knowledge translation has the potential to increase the relevance, applicability, and use of research findings. This approach has been increasingly utilized in health research in recent years. However, the extent to which it has been applied in preclinical research and its effectiveness are unknown. To address this gap, we will conduct a scoping review to map the current use, potential benefits, and challenges of iKT in preclinical research.
MethodsGuided by a modified Arksey and O’Malley’s scoping review framework, we will systematically search reference lists and key research databases including Medline, Embase, PsycINFO, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and Web of Science. Peer-reviewed articles written or translated in English that focus on iKT or approaches that align with iKT within the context of preclinical research will be included. This review will be conducted as part of the Improving Neuroplasticity through Spaced Prefrontal intermittent-Theta-Beta-Stimulation REfinement in Depression (INSPiRE-D) project, which features preclinical research from mouse models to human work (Grant number CAMH File No.22-060). The project’s multidisciplinary team and knowledge user advisory committee will be consulted at key points throughout the scoping review process. A person with lived experience co-chairs the project advisory committee, co-authored this manuscript, and will be routinely included in the decision-making process of the scoping review.
Background
Older adults from specific racial and ethnic minoritized groups experience disproportionately higher asthma prevalence, morbidity, and mortality. They also often use emergency departments (EDs) to manage their asthma. High-quality primary care can improve asthma control and prevent ED use. Nurse practitioners (NPs) provide an increasing proportion of primary care to minoritized patients, yet often, they work in poor work environments that strain NP care.
Objectives
We examined whether racial and ethnic health disparities in ED visits among older adults with asthma are moderated by the NP work environment in primary care practices.
Methods
In 2018–2019, we used a cross-sectional design to collect survey data on NP work environments from 1,244 NPs in six geographically diverse states (i.e., Arizona, California, New Jersey, Pennsylvania, Texas, and Washington). We merged the survey data with 2018 Medicare claims data from 46,658 patients with asthma to assess the associations of all-cause and ambulatory care-sensitive conditions, ED visits with NPs’ work environment, and race and ethnicity using logistic regression.
Results
More than one third of patients with asthma visited the ED in 1 year, and a quarter of them had an ambulatory care-sensitive condition ED visit. Black and Hispanic patients were more likely than White patients to have all-cause and ambulatory care-sensitive condition ED visits. NP work environment moderated the association of race with all-cause and ambulatory care-sensitive condition ED visits among patients with asthma. Greater standardized NP work environment scores were associated with lower odds of all-cause and ambulatory care-sensitive condition ED visits between Black and White patients.
Discussion
Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with more favorable NP work environments. Preventing unnecessary ED visits among older adults with asthma is a likely benefit of favorable NP work environments. As the NP workforce grows, creating favorable work environments for NPs in primary care is vital for narrowing the health disparity gap. Background
Readmissions following hospitalization for common surgical procedures are prevalent among older adults and are disproportionally experienced by Hispanic patients. One potential explanation for these disparities is that Hispanic patients may receive care in hospitals with lower-quality nursing care.
Objectives
The objective of this study was to evaluate the relationship between the hospital-level work environment of nurses and hospital readmissions among older Hispanic patients.
Methods
Using linked data sources from 2014 to 2016, we conducted a cross-sectional analysis of 522 hospitals and 732,035 general, orthopedic, and vascular surgical patients (80,978 Hispanic patients and 651,057 non-Hispanic White patients) in four states. Multivariable logistic regression models were employed to determine the relationship between the work environment and older Hispanic patient readmissions at multiple time periods (7, 30, and 90 days).
Results
In final adjusted models that included an interaction between work environment and ethnicity, an increase in the quality of the work environment resulted in a decrease in the odds of readmission that was greater for older Hispanic surgical patients at all time periods. Specifically, an increase in three of the five work environment subscales (Nurse Participation in Hospital Affairs, Nursing Foundations for Quality of Care, and Staffing and Resource Adequacy) was associated with a reduction in the odds of readmission that was greater for Hispanic patients than their non-Hispanic White counterparts.
Discussion
System-level investments in the work environment may reduce Hispanic patient readmission disparities. This study’s findings may be used to inform the development of targeted interventions to prevent hospital readmissions for Hispanic patients. 
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