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Polypharmacy in older adults is a growing concern, particularly in general practice (GP), where general practitioners (GPs) are the main prescribers managing complex multimorbidity. While often necessary, polypharmacy increases the risk of potentially inappropriate prescribing (PIP), adverse drug events, hospitalisations and reduced quality of life. Although clinical medication reviews using specific tools are frequently employed to address these risks and guide a safe deprescribing process, the specific role and effectiveness of educational interventions—as a component of prescribers’ behavioural change—remain inconsistently evaluated. The objective of this review is to identify, describe and evaluate educational interventions targeting GPs, aimed at improving medication appropriateness and promoting deprescribing in older adults with polypharmacy in GP settings.
This systematic review protocol follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols guidelines. Eligible study designs include randomised controlled trials (RCTs), cluster RCTs and quasi-experimental studies. Studies must target GPs, GP trainees or primary care physicians and report outcomes related to medication appropriateness, measured using validated tools (eg, Medication Appropriateness Index, Screening Tool of Older Person’s Prescriptions/Screening Tool to Alert to Right Treatment). Secondary outcomes include hospital admissions, quality of life, prescribing behaviour, medication-related harms and cost-effectiveness. In addition to evaluating effectiveness, we will characterise heterogeneity in educational content and objectives, duration/intensity, theoretical or pedagogical underpinnings, delivery format, implementation fidelity and contextual factors. A comprehensive search will be conducted in MEDLINE, EMBASE, CINAHL and CENTRAL without language or date restrictions. The systematic review will follow PRISMA 2020 guidelines for data synthesis, and if meta-analysis is not feasible, Synthesis Without Meta-analysis reporting guidelines will be used.
Findings will be disseminated through peer-reviewed publications and conference presentations. Results will inform the design of future educational strategies to optimise medication review and deprescribing practices in general practice and primary care, by identifying which approaches most effectively improve patient-centred outcomes and clarifying the role of educational components within complex, multicomponent interventions.
Patients with metastatic oncogene-driven non-small cell lung cancer (NSCLC) are experiencing longer and uncertain trajectories of life-limiting illness due to advances in precision medicine. These advanced cancer survivors face new challenges related to living with uncertainty and desire more support to maximize their health and quality of life. Therefore, we developed a population-specific, blended palliative and survivorship care intervention to address the supportive care needs of patients recently diagnosed with advanced lung cancer and who are receiving targeted therapy for NSCLC with EGFR, ALK, ROS1 or RET driver mutations.
This study is a single-site, non-blinded pilot randomised controlled trial of an intervention for patients with metastatic oncogene-driven NSCLC, Patient-centred, Optimal Integration of Survivorship and palliative carE (POISE) versus usual care. POISE consists of a brief series of structured visits with a trained palliative care clinician to address coping with uncertainty, increase prognostic awareness and promote healthy lifestyle behaviours. We will recruit 60 patients from the Massachusetts General Hospital Cancer Center. Patients will be randomised into a 1:1 ratio to the intervention arm or the usual care arm. Patients randomised to the intervention arm will complete four 60 min virtual or in-person visits with a palliative care physician. The usual care arm will receive standard oncology care. Patients in both arms will complete survey assessments at enrolment, 12 weeks and 20 weeks after enrolment, and patients in the intervention group will complete an exit interview. The primary outcome measure of this trial is feasibility, which will be defined by ≥60% enrolment among eligible patients, ≥70% completion of all sessions for participants in the intervention arm and ≥70% completion of all surveys for all study participants. Exploratory outcomes include acceptability, emotional coping with prognosis, self-efficacy for chronic disease management, prognostic awareness, quality of life, anxiety, depression, intolerance of uncertainty and documentation of goals and values discussions in the electronic health record.
This study was approved by the Dana-Farber/Harvard Cancer Center’s institutional review board (protocol 20-722). The protocol is reported in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines, and the study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials.
Preventing online and offline sexual harassment (SH) is a public health priority, due to its worldwide magnitude and short- and long-term consequences to the victims and survivors. Universities are environments that may facilitate different forms of conflicts, including SH, but they also play a key role in preventing and addressing them. This paper describes ‘Uni4Equity’, a European project funded by the CERV-2022-DAPHNE Programme of the European Union (Ref. 101094121-Uni4Equity) aimed to reinforce universities’ readiness to identify, map and respond to online and offline SH at workplace and other relevant settings (classrooms, digital space), with an explicit (but not exclusive) focus on minority social groups. More specifically, the project will address the research needs of conducting multidimensional diagnosis of SH at universities (scale and determinants) as a basis for preventive actions; assessing the effectiveness of preventive interventions such as social media campaigns and training workshops; creating a university culture that actively rejects SH; improving access to existing support services; and contributing to the acknowledgement of universities as an asset in preventing this issue.
The project follows an exploratory sequential design for the period 2023–2026. In phase 1, a mixed-method initial assessment based on online surveys, semistructured interviews and desk reviews is planned in six targeted universities: University of Alicante, Adam Mickiewicz University (AMU), University of Maia, University of Applied Sciences Burgenland (UASB), University of Antwerp (UAntwerp), University of Verona. Phase 2 integrates long-term and large-scale interventions at different levels of prevention (primary, secondary and tertiary) and implementation (interpersonal, institutional and social). These interventions combine online and offline training programmes addressed to students and staff, arrangements with internal and external support services and improvements in access to information and resources, including SH protocols and regulations. Phase 3 consists of qualitative and quantitative evaluations of the different Uni4Equity interventions and a final evaluation of the global impact of the project.
Ethical approval was obtained by the different universities research ethics committees (Universidad de Alicante, vice-rectorate for research: Ref. no. UA-2023-03-27; Università di Verona, Comitato di Approvazione per la Ricerca sulla Persona: Ref. no. UNIVR-24/2023; UAntwerp, Ethics Committee for the Social Sciences and Humanities: Ref. no. EX_SHW_2023_38_1; AMU, Ethics Committee for Research Involving Human Participants, Ref. no. UAM_19/2022/2023; UASB, Ethics Committee: Ref. no. UASB _28/08/2023; Universidade da Maia, Conselho de Ética e Deontologia: Ref. no. UMAIA_ 151/2023).
The research team will disseminate findings through peer-reviewed journal articles, presentations in scientific national and international events, policy briefs, infographics, videos and short reports.
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